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INTRODUCTION: This study investigated how patients with COVID-19, telemonitoring (TM) teams, general practitioners (GPs) and primary care nurses in Belgium experienced remote patient monitoring (RPM) in 12 healthcare organizations, in relation to the patients' illness, health, and care needs, perceived quality of care, patient and health system outcomes, and implementation challenges. DESIGN: A qualitative research approach was adopted, including focus group discussions and semi-structured interviews. METHODS: Four different groups of participants were interviewed, that is, patients (n = 17), TM teams (n = 27), GPs (n = 16), and primary care nurses (n = 12). An interview guide was drafted based on a literature review. Interviews were transcribed verbatim, and NVivo was used for managing and analyzing the data. The QUAGOL method was used to guide the data analysis process and was adapted for the purpose of a thematic content analysis. RESULTS: All participants agreed that RPM-reassured patients. The overall perceived value of RPM for individual patients depended on how well the intervention matched with their needs. Patients who did not have the necessary language (Dutch/French speaking) and digital skills, who did not have the right equipment (smartphone or tablet), or who missed the necessary infrastructure (no internet coverage in their region) were often excluded. Remote patient monitoring also reassured healthcare professionals as it gave them information on a disease they had little knowledge about. Professionals involved in RPM experienced a high workload. All TM teams agreed that quality of data was a key factor to ensure an adequate follow-up, but they differed in what they found important. The logistic management of RPM was a challenge because of the contagious character of COVID-19, and the need for an effective information flow between the hospital team and primary care providers. Participants missed clarification about who was accountable for the care for patients in the projects. Primary care nurses and GPs missed access to RPM data. All agreed that the funding they received was not sufficient to cover all the costs associated with RPM. CONCLUSION: Healthcare professionals and patients perceive RPM as valuable and believe that the concept will have its place in the Belgium health system. However, current RPM practice is challenged by many barriers, and the sustainability of RPM implementation is low. CLINICAL RELEVANCE: Remote patient monitoring (RPM) was perceived as a valuable intervention for patients with COVID-19, but there were important concerns about unequal access to care. While the technology for RPM is available, the sustainability of implementation is low because of concerns with data quality, challenging logistics within projects, lack of data integration and communication, and a lack of an overarching guiding framework. ispartof: JOURNAL OF NURSING SCHOLARSHIP vol:55 issue:1 pages:67-78 ispartof: location:United States status: published

ICTs have been increasingly involved in teaching–learning processes due to the potential offered by the tools as well as to the set of demands derived from the political and health situations of the social environment. In this sense, the introduction of virtual campuses as complex systems that centralize the entire technological component that complements traditional teaching processes has meant a change of paradigm with repercussions at the teaching and pedagogical level. In this context, the purpose of this study aims to analyze students’ perception of the use of virtual campus and how to enhance the quality of the educational process using intelligent systems. For this purpose, 318 students that use virtual campus have been surveyed. The results show that there are three variables that predominantly influence the quality of teaching–learning processes using virtual campuses: frequent contact with teachers through the platform, the digital competence of the student, and the adaptation of training content to the students’ prior knowledge. This information can be useful, as it allows them to establish guidelines to guide the practices of their teaching teams in technological environments, guaranteeing the suitability of the teaching–learning process and improving the evaluation processes and the assessment of their own educational work.

Cette présentation vise à partager une approche d'analyse des contextes de soins. Dans ces contextes, les infirmières et autres prestataires de soins primaires sont impliqués dans les soins des patients atteints de plaies chroniques soignés à domicile et dans des situations de vie complexes. En Europe, les personnes atteintes de plaies chroniques sont principalement soignées à domicile par des infirmières et d'autres prestataires de soins primaires. Les plaies chroniques sont généralement associées à l'âge, à la présence de maladies chroniques et à la vulnérabilité, ce qui crée des besoins multiples. Cela signifie que de nombreux prestataires de soins peuvent être impliqués dans leurs soins, ce qui peut compromettre la continuité des soins et générer un besoin accru de coordination des soins. La combinaison de facteurs spécifiques au patient et l'interaction avec de multiples prestataires créent des contextes de soins très différents, avec des ressources et des obstacles spécifiques. En raison de ces interactions de facteurs multiples, la situation peut être décrite comme complexe. Nous avons recueilli des récits de prestataires de soins (principalement des infirmières) par le biais d'entretiens et de groupes de travail dans le cadre d'un atelier. Ces histoires sont basées sur les expériences des participants dans divers contextes de soins à domicile de personnes souffrant de plaies chroniques. Au vu de la complexité des situations mais aussi des matériaux, nous avons opté pour une approche réaliste (identification de différentes hypothèses sous forme de contexte-mécanismes-résultats). L'analyse a permis d'identifier des relations hypothétiques entre la collaboration interprofessionnelle, les facteurs spécifiques aux patients et le rôle des infirmières qui ont un impact sur la continuité. Les facteurs contextuels semblent façonner le rôle des infirmières de soins primaires, restreignant ou élargissant leur potentiel d'action pour la pratique collaborative coordonnée.

The B-cell lymphoma 2 (Bcl-2) family of proteins is the main regulator of apoptosis. However, multiple emerging evidence has revealed that Bcl-2 family proteins are also involved in cellular senescence. On the one hand, the different expression of these proteins determines the entry into senescence. On the other hand, entry into senescence modulates the expression of these proteins, generally conferring resistance to apoptosis. With some exceptions, senescent cells are characterized by the upregulation of antiapoptotic proteins and downregulation of proapoptotic proteins. Under physiological conditions, freshly formed tetraploid cells die by apoptosis due to the tetraploidy checkpoint. However, suppression of Bcl-2 associated x protein (Bax), as well as overexpression of Bcl-2, favors the appearance and survival of tetraploid cells. Furthermore, it is noteworthy that our laboratory has shown that the joint absence of Bax and Bcl-2 antagonist/killer (Bak) favors the entry into senescence of tetraploid cells. Certain microtubule inhibitory chemotherapies, such as taxanes and vinca alkaloids, induce the generation of tetraploid cells. Moreover, the combined use of inhibitors of antiapoptotic proteins of the Bcl-2 family with microtubule inhibitors increases their efficacy. In this review, we aim to shed light on the involvement of the Bcl-2 family of proteins in the senescence program activated after tetraploidization and the possibility of using this knowledge to create a new therapeutic strategy targeting cancer cells.

Objectives In this study, the authors hypothesized that intraprocedural improvement of pulmonary venous (PV) waveforms are predictive of improved outcomes. In this report, they analyzed intraprocedural invasive and echocardiographic changes with respect to rehospitalization and mortality. Background The effects of hemodynamic changes during percutaneous mitral valve repair (PMVR) with MitraClip (Abbott Vascular, Santa Clara, California) are incompletely characterized. Methods The authors retrospectively reviewed records and intraprocedural transesophageal echocardiograms of 115 consecutive patients (age 76 ± 12 years) who underwent PMVR for mitral regurgitation (MR) from May 2013 to January 2017 at Emory University Hospital. They assessed intraprocedural PV waveforms for improvement in morphology, measured change in MR grade by semiquantitative methods, evaluated invasive changes in left atrial pressure (LAP) and V-wave, and compared with 30-day and 1-year rehospitalization and all-cause mortality. Results Ninety-three cases (80%) had PV waveforms before and after clip placement sufficient for analysis, of which 67 (73%) demonstrated intraprocedural improvement in PV morphology and 25 (27%) did not. At 24 months, 57 (85%) of those with PV improvement were living, compared with only 10 (40%) of those without improvement. Proportional hazards models demonstrated a significant survival advantage in those with PV improvement (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.08 to 0.93, p = 0.038). By multivariable analysis, PV improvement predicted reduced 1-year cardiac rehospitalization (odds ratio [OR]: 0.18, p = 0.044). Intraprocedural assessment of MR grade and invasive hemodynamics did not consistently predict mortality and rehospitalization. Conclusions PV waveforms are important markers of procedural success after PMVR. Our data show intraprocedural PV waveforms may predict rehospitalization and mortality after PMVR. A larger, multicenter cohort will be important to clarify this relationship.

Transcatheter mitral valve replacement (TMVR) is a promising strategy for patients with mitral valve disease and no surgical options. Left ventricular outflow tract (LVOT) obstruction is a life-threatening complication of TMVR. Although there are no commercially available devices to prevent LVOT obstruction, the risk of it can be reduced by careful preprocedure planning and the use of novel modifications to commercially available devices. This article summarizes current techniques to prevent LVOT obstruction with an emphasis on electrosurgical strategies.

The retinoblastoma protein (Rb) and its homologs p107 and p130 are critical regulators of gene expression during the cell cycle. Functional inactivation of Rb family proteins leads to loss of cell-cycle control and promotes genome instability and proliferation, which are hallmarks of cancer. Rb proteins share a structural domain, known as the “pocket domain”, which mediates association with a large number of cellular proteins. A cleft in the pocket domain binds an LxCxE sequence motif in these proteins, many of which function with Rb proteins to co-regulate transcription during quiescence and G1. Proteins from oncogenic DNA viruses also bind this cleft to inactivate Rb family proteins, and the E7 protein from the human papillomavirus has been used as the primary model for understanding LxCxE motif interactions. Evidence presented previously and here demonstrates that the E7 sequence binds tighter and competes with cellular proteins for the LxCxE site, but the molecular basis for the relatively weak affinities of the cellular proteins has been poorly understood. Here, we present binding data and a series of crystal structures of the p107 pocket domain in complex with LxCxE peptides derived from the transcriptional co-repressor proteins HDAC1, ARI4DA, and EID1. The structures reveal determinants of protein binding beyond the L-C-E core that include the N and C-terminal sides of the LxCxE motif and the x (wild card) residues. Our results explain how differences in these interactions outside the L-C-E core result in weaker affinities of pocket protein for cellular LxCxE proteins compared to E7 and result in differences in Rb and p107 affinities for some LxCxE-containing sequences. Our study provides new insights into how Rb proteins bind their myriad of cell partners and lays the foundation for structure-based design of peptides that inhibit oncogenic viral protein interactions.

The development of a binder-free material is gaining ground as a flexible anode in lithium-ion batteries due to the higher specific capacity and possibilities of usage in portable appliances. In this work, magnetite nanoparticles (Fe3O4-NPs) were incorporated into carbon microfibers (CMFs) by electrospinning technique to improve the specific capacity of active material, retaining the high flexibility of the CMFs. The composite active material (CMFs-Fe3O4) was characterized by Raman spectroscopy, Thermogravimetric analyses (TGA), and transmission electron microscopy (TEM) to determine the composition, structure, and morphology of the composite. Electrochemical tests were done to evaluate the performance of the composite material as an anode in lithium-ion batteries. Fe3O4-NPs with particle sizes from 30 to 40 nm were incorporated into CMFs (800 nm), and the TEM images showed a homogeneous distribution of Fe3O4-NPs. The electrochemical tests evidenced that magnetite incorporation increases the specific capacity by 42% on the first cycle and 20% on the 50th cycle. Similarly, the Coulombic efficiency increases by 20% in the composite material.

Particulate matter (PM) is one of the most problematic pollutants in urban air. The effects of PM on human health, associated especially with PM of ≤2.5μm in diameter, include asthma, lung cancer and cardiovascular disease. Consequently, major urban centers commonly monitor PM2.5 as part of their air quality management strategies. The Chemical Transport models allow for a permanent monitoring and prediction of pollutant behavior for all the regions of interest, different to the sensor network where the concentration is just available in specific points. In this chapter a data assimilation system for the LOTOS-EUROS chemical transport model has been implemented to improve the simulation and forecast of Particulate Matter in a densely populated urban valley of the tropical Andes. The Aburrá Valley in Colombia was used as a case study, given data availability and current environmental issues related to population expansion. Using different experiments and observations sources, we shown how the Data Assimilation can improve the model representation of pollutants.

BACKGROUND: The twelve Integrated Care Program pilot projects (ICPs) created by the government plan 'Integrated Care for Better Health' aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme. METHODS: A scientific team was commissioned to co-design and implement an evaluation protocol in close collaboration with the government, the ICPs and several other involved stakeholders. RESULTS: A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Processes and outcomes of all the projects will be monitored using indicators based on administrative data on population health and the quality and costs of care. A yearly survey will be organized to collect data on patient-reported outcomes and experiences and on provider-reported measures of inter-professional collaboration and proper wellbeing. Using both quantitative and qualitative data, we will develop theories about the mechanisms and the associated contextual factors that lead to integrated care and the Quadruple Aim outcomes. DISCUSSION: The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs. Some challenges due to the large scale of the project and the multiple stakeholders involved may impede the successful implementation of this proposal. BACKGROUND: The twelve Integrated Care Program pilot projects (ICPs) created by the government plan 'Integrated Care for Better Health' aim to achieve four outcome types (the Quadruple Aim) for people with chronic diseases in Belgium: improved population health, improved patient and provider experiences and improved cost efficiency. The aim of this article is to present the development of a mixed methods realist evaluation of this large-scale, whole system change programme. METHODS: A scientific team was commissioned to co-design and implement an evaluation protocol in close collaboration with the government, the ICPs and several other involved stakeholders. RESULTS: A protocol for a mixed methods realist evaluation was developed to gain insights into the mechanisms that foster successful results in ICPs. The qualitative evaluation proposed will be based on the document analysis of yearly ICP progress reports, selected case studies and focus group interviews with stakeholders. Processes and outcomes of all the projects will be monitored using indicators based on administrative data on population health and the quality and costs of care. A yearly survey will be organized to collect data on patient-reported outcomes and experiences and on provider-reported measures of inter-professional collaboration and proper wellbeing. Using both quantitative and qualitative data, we will develop theories about the mechanisms and the associated contextual factors that lead to integrated care and the Quadruple Aim outcomes. DISCUSSION: The objective of this study is to deliver policy recommendations on strategies and best practices to improve care integration in Belgium and to implement a sustainable monitoring system that serves both policy makers and the stakeholders within the ICPs. Some challenges due to the large scale of the project and the multiple stakeholders involved may impede the successful implementation of this proposal. ispartof: International journal of integrated care vol:20 issue:3 ispartof: location:England status: published

Background: Despite research on the molecular bases of Alzheimer’s disease (AD), effective therapies against its progression are still needed. Recent studies have shown direct links between AD progression and neurovascular dysfunction, highlighting it as a potential target for new therapeutics development. In this work, we screened and evaluated the inhibitory effect of natural compounds from native Peruvian plants against tau protein, amyloid beta, and angiotensin II type 1 receptor (AT1R) pathologic AD markers. Methods: We applied in silico analysis, such as virtual screening, molecular docking, molecular dynamics simulation (MD), and MM/GBSA estimation, to identify metabolites from Peruvian plants with inhibitory properties, and compared them to nicotinamide, telmisartan, and grapeseed extract drugs in clinical trials. Results: Our results demonstrated the increased bioactivity of three plants’ metabolites against tau protein, amyloid beta, and AT1R. The MD simulations indicated the stability of the AT1R:floribundic acid, amyloid beta:rutin, and tau:brassicasterol systems. A polypharmaceutical potential was observed for rutin due to its high affinity to AT1R, amyloid beta, and tau. The metabolite floribundic acid showed bioactivity against the AT1R and tau, and the metabolite brassicasterol showed bioactivity against the amyloid beta and tau. Conclusions: This study has identified molecules from native Peruvian plants that have the potential to bind three pathologic markers of AD.

Resumen Introduccion y objetivo La disociacion albuminocitologica en el liquido cefalorraquideo (LCR) apoya el diagnostico de sindrome de Guillain-Barre (SGB) pero no ayuda en el pronostico, por lo que el objetivo de este estudio es determinar la utilidad de las cifras de proteinas en el LCR para predecir la evolucion en pacientes pediatricos. Pacientes y metodos Se realizo un estudio de prueba diagnostica, en pacientes pediatricos con SGB, analizando variables sociodemograficas, clinicas y proteinas en LCR, asi como electromiografia; tambien se documento la presencia de disautonomias. Resultados Se analizaron datos de 23 pacientes, predominando el sexo masculino (87%), la edad escolar (43,5%) y el antecedente de infeccion digestiva (73,9%). Mediante la curva COR se encontro, para la presencia de disautonomias, un area bajo la curva de 0,966 con mejor punto de corte de proteinas en LCR de 87-92 proteinas/mm, y para evaluar la pobre respuesta al tratamiento con inmunoglobulina intravenosa, de 0,969, con mejor punto de corte en 157 proteinas/mm. Conclusion La cantidad de proteinas en el LCR puede utilizarse como un indicador pronostico y de gravedad, de tal manera que unas proteinas mayores de 100 en el LCR se traducen en una evolucion torpida y con mayores complicaciones.

Introduction and objective The albumin-cytologic dissociation in cerebrospinal fluid (CSF) supports the diagnosis of Guillain–Barre syndrome (GBS) but does not support the prognosis, so the aim of this study is to determine the usefulness of protein numbers in the CSF to predict progression in pediatric patients. Patients and methods A diagnostic test was performed in pediatric patients with GBS, analysing sociodemographic, clinical and protein variables in CSF as well as electromyography. The presence of dysautonomia was also documented. Results Data were analyzed from 23 patients, predominantly males (87%), school age (43.5%) and history of digestive infection (73.9%). Using the ROC curve, an area under the curve of 0.966 with best CSF protein cut-off point of 87–92 proteins/mm was found for the presence of dysautonomias and to evaluate the poor response to treatment with 0.969 intravenous immunoglobulin with better cut-off point in 157 proteins/mm. Conclusion The amount of proteins in the CSF can be used as a prognostic indicator and severity, such that proteins greater than 100 in CSF translate into a torpid evolution and with greater complications.

Introducción: Los niveles bajos de vitamina D se han asociado con una gama de condiciones clínicas como obesidad, resistencia a la insulina y diabetes mellitus. Existen pocos estudios donde se hayan realizado mediciones de la forma activa de la vitamina D (1,25 (OH)2 vitamina D) en niños con obesidad. Sin embargo, los datos publicados no son concluyentes. El objetivo de este estudio fue determinar los niveles de la forma activa de la vitamina D en niños con obesidad y sobrepeso y determinar la asociación entre los niveles bajos de esta vitamina, la obesidad y las alteraciones del metabolismo de la glucosa. Métodos: Estudio transversal analítico en niños de 6 a 12 años de edad con exceso de adiposidad determinado por el índice cintura-estatura y el índice Z de masa corporal. Se midieron niveles de glucosa, insulina, perfil de lípidos completo, modelo homeostático para evaluar la resistencia a la insulina y la forma activa de la vitamina D. Se consideraron como niveles bajos de vitamina D aquellos menores a 30 pg/ml. Resultados: La prevalencia de niveles bajos de la forma activa de la vitamina D fue del 36%. La asociación entre niveles bajos de la forma activa de la vitamina D y niveles altos de insulina resultó estadísticamente significativa. No se encontró asociación significativa entre los niveles de la vitamina y las medidas de adiposidad. Conclusiones: Se encontraron niveles bajos de la forma activa de la vitamina D en el 36% de la población estudiada, y se demostró su asociación con la resistencia a insulina e hiperinsulinemia.

La denominada mision HIPAE (Helicopter-borne In-situ Pollution Assessment Experiment) desarrollo una prueba de concepto dentro de una aeronave de la Fuerza Aerea Colombiana, sobrevolando el Valle de Aburra para transportar dos tipos de contadores de particulas PM2.5 y PM10, asi como dos versiones de las plataformas en desarrollo llamadas Simple para medir variables meteorologicas (humedad relativa, presion barometrica, temperatura), altitud, geo-posicion y ocho tipos de gases CO 2 , H 2 , NO 2 , NH 3 , C 2 H 6 OH, CH 4 , C 4 H 10 , C 3 H 8 . Adicionalmente, un experimento con nano filtros demostro su capacidad para capturar material particulado, el cual fue analizado mediante microscopia electronica de barrido combinada con espectroscopia de rayos-X (EDX). Los resultados de EDX arrojaron informacion valiosa sobre la morfologia y quimica a nivel de particula en la atmosfera urbana por encima de la altura de las estaciones de medicion tradicionales. Fue posible visualizar en los datos altas concentraciones de compuestos de aerosol y gases como CO, NO 2 y CH 4 , cuyos valores fueron menores en areas rurales y forestales en comparacion con areas urbanas segun lo esperado. La plataforma Simple mostro un comportamiento adecuado manteniendose dentro de sus niveles de incertidumbre, indicando la utilidad de los datos adquiridos como primer paso a siguiente ejercicio para ser utilizadas en aeronaves comerciales o militares con el objetivo de suministrar constantemente, a los modelos meteorologicos y quimicos de transporte, informacion in-situ para actividades de asimilacion de datos basadas en ensamble, tanto secuencial (EnKF) como variacionalmente (4DenVar), como en actividades de fusion de datos para la toma de decisiones.

"El propósito central de esta investigación, es averiguar qué fue la Obra Cultural Universitaria. Además, trataremos de entender por qué existen, por lo menos, dos grandes versiones sobre lo que fue la OCU que, además, se contradicen entre sí. Por último, trataremos de averiguar si la participación de los estudiantes denominados OCU en procesos como la lucha por la autonomía de la Universidad de Nuevo León, la marcha estudiantil del 10 de junio de 1971 en la Ciudad de México, y la posterior radicalización de algunos de sus miembros, se debió a una influencia marxista; al influjo de las realidades contextuales dentro y fuera de la iglesia; o a la suma de todos esos elementos".

Peanut is a widespread legume, with an important agricultural and economic significance. It symbiotically interacts with rhizobia, increasing atmospheric nitrogen assimilation by the biological nitrogen fixation process, therefore improving yield. The presence of the environmental pollutant arsenic and the occurrence of water deficit episodes constitute severe abiotic stresses affecting this symbiosis, being biostimulants a sustainable alternative to increase crop yields. Thus, the objective of this work was to determine the effects of the joint application of a commercial seed non-microbial plant biostimulant (Nutrifer® 202) and a microbial plant biostimulant on growth, nodulation and oxidative stress indicator-levels, on peanut plants exposed to arsenic or drought. Biostimulant addition reduced As translocation to leaves and improved plant growth and nodulation in the drought stress condition, in association with proline accumulation, with a protective function on the cellular redox balance. Therefore the application of the biostimulant combination Nutrifer® 202 and Bradyrhizobium sp. C-145 is promising for peanut crops growing in regions susceptible to water deficit or arsenic exposure.

Objective To clinically characterize a group of thrombocytopenic dogs that received cryopreserved platelet concentrate (cPC) transfusion, assess efficacy of cPC treatment in improving patient outcome, and compare treated dogs to a control population of thrombocytopenic dogs that did not receive cPC transfusions. Design Retrospective study. Setting University teaching hospital. Animals Eighty-six client-owned dogs (43 in treatment group, 43 in control group). Interventions None. Measurements and Main Results Medical records of thrombocytopenic dogs that received cPC transfusions and those of thrombocytopenic dogs that did not receive cPC (control population) from January 2007 through March 2013 were reviewed. Dogs receiving cPC were statistically more likely than controls to have a platelet trigger for cPC transfusion (P = 0.01), lower platelet count (P = 0.009) and hematocrit at presentation (P = 0.001), and lower hematocrit after cPC (P = 0.02). Although there was a statistically significant increase in platelet count from pre- to post-cPC transfusion (P = 0.002), cPC was not found to be effective in improving clinical bleeding or increasing survival compared to the control group. No other characteristics were statistically different between groups. No dogs receiving cPC had an acute transfusion reaction during hospitalization. Conclusions In the population described in this study, cPC was not found to increase survival, but was well tolerated. Controlled, prospective studies are necessary to determine indications for and efficacy of cPC transfusions.

Background: The Belgian government program “Integrated Care for better health” (www.integreo.be) aims at a Nation-wide Whole System Change in health and social care towards Integrated Care (IC), by means of geographically defined pilot projects. Each of the +/- 20 pilot projects will implement IC in a loco-regional area covering up to 150.000 inhabitants. The ultimate goal is to improve the ‘Triple Aim’ quality of care,equity and healthcare professional work life (‘TA2+’). Pilot projects will run for several years serving both as large-scale implementation projects and test cases. Successful projects will be upscaled to cover – ultimately - the entire Belgian territory. A scientific team was appointed for evaluation of the projects. A priority task for this team is to set up sustainable monitoring tools that can evaluate the projects in a longitudinal way. To evaluate the impact of Integreo on TA2+, both content (outcome indicators) and methods of data collection must be defined. However, the scale of the projects - both concerning the number of included persons and the duration of the project - is incompatible with the usual approach of data collection and analysis. Aim: To reflect with the target audience on the process and dynamics of selecting outcome indicators and data collection methods for such large-scale projects. Format: Interactive workshop with ‘teasing’ questions to the target audience combind with presentation of the lessons learned. This workshop follows Part I and – if necessary – both can be given in one workshop. Speakers on behalf of the research group: Elien Colman, Elias Van Deun, Jean Macq, Geert Goderis Target Audience: Researchers and professionals active in the field of IC and system change. Learnings: 1- On the indicator selection - Define their utility: the quantitative evaluation of the indicators alone will not allow to determine causal relationships, but must be part of a global analysis, including qualitative research methods and implementation evaluation. - Set goals: first define the indicator set by evaluating the added value for measuring the change objectives. - Find an equilibrium between ambition and feasibility. The impossibility to use usual data collection methods has a direct impact on the indicator selection itself. - Define transversal indicators first as a common base for all projects. Afterwards, add project-specific indicators in full co-creation. 2- On the research methodology - The methods of data collection must be routinely applicable and sustainable in the long running. - The collected data from hospitals, General Practice, Patient Reported Outcomes, etc., must also be as much as possible routinely collected and automatically merged with claims data at patient level. - Plan with a clear time line: -- Evolving technological, legal and practical issues determine the data collection possibilities -- Each new database adds complexity to an already complex project: therefore, start small, plan expansion at the appropriate moment. 3- On the co-creation process - It requires time and organization to involve all necessary actors, allowing them to review and process the data. - Moving from existing logics of intra-organisational data-analysis (e.g. in hospitals), towards inter-organisational data-analysis.

Background : The Belgian government program “Integrated Care for better health” www.integreo.be aims at a Nationwide Whole System Change in health and social care. This implies change in its structures, finances, processes and paradigms towards more Integrated Care IC. It concerns geographically defined pilot projects that should cover in ‘full implementation” more than 3.670.000 people, about one third of the total Belgian Population. Pilot projects are both large-scale implementation projects and test cases. Each pilot aims at changing the organization of their loco-regional area network covering up to 150.000 inhabitants towards more IC. Changes are directed at 14 components, structured at three levels: 1 the patient level e.g. case management; 2 the inter-professional collaboration level e.g. shared medical file; and 3 the inter-organizational collaboration at loco-regional level e.g. quality culture The ultimate goal is to improve the ‘Triple Aim’ quality of care, equity and the work life of healthcare providers ‘TA2+’. A scientific team was appointed to : design and implement an evaluation framework alongside the pilot-projects-in-development. function as a support mechanism to the pilot projects in assisting and accompanying them with their self-evaluation process. function as a support mechanism for the government agencies who induced and guide the change management program. Existing research on achieving sustainable change of loco-regional networks towards more IC and Triple Aim within a nation-wide program is scarce. Moreover, existing research is highly context specific. This need to be taken into account in the generalization process. Aim : To reflect with the target audience on the necessity of changing research paradigms towards theory driven appraisals when engaging into Whole System Change evaluation in healthcare. Format : Interactive workshop with both ‘teasing’ questions to the target audience and presentation of our lessons learned Speakers: Geert Goderis, Jean Macq, Nathan Charlier, Elien Colman. Target Audience : Researchers and professionals active in the field of IC and system change. Learnings : - System change towards IC cannot be conceived as a delineated intervention, but as a complex strategy or even a policy to innovate and implement long-lasting change. This complexity often manifests as shifting and unpredictable contexts, deep differences among perspectives, and even conflict among stakeholders. - Scientific evaluation is necessary and imposes a paradigm change for the involved scientists. ‘Laboratory like’ methodologies type ‘Randomized Controlled Trials’ are unfit and must be replaced by theory driven approaches, describing the processes and contextual factors leading to desired outcomes. - The evaluation should transcend the question ‘what works?’ towards questions on how, why, for whom and in what circumstances the program brings the desired outcomes, in order to allow upscaling of the program to a system change covering entire Belgian territory. - Scientists engage in a co-creative process producing new knowledge, in partnership with all other involved stakeholders like e.g. health professionals and government agents. This co-creation process disables the possibility to plan a fixed endpoint: the design is tribute to multiple issues that evolve over time. Meanwhile, the whole program serves as a leverage to create breakthroughs in these issues.