"The World of the [open] innovator" described the background of the revolution we are in in innovation and what the consequences are for innovation, changing towards design driven open innovation. We reframed innovation to meet new needs and values of companies and organizations in our work field. We do not take this light-hearted. We know the field of innovation and used our experience and conversation with stakeholders to come up with the insight of The [open] Innovator. What strengthened us were reactions from companies and organization we asked to cocreate or participate. There seemed to be an instant recognition and appeal to our vision and approach. But we also realize that we are in the stage of prototyping and we need you, as our lead users to be critical, yet to trust us. You, being an [open] innovator, will do great wonders, because you will be taught to deal with this uncertainty and dig in new, unknown situations or problems. You will learn the tools for research, for communication, for visualization. You will become a cooperative, open-minded problem solver. You will be able - with all the skills and tools we will provide you - to make the difference. But we need you to reflect upon your progress and needs; help us to get an insight in to your uncertainties, values and unmet needs, to enable us to improve our thinking and teaching. However, innovation can only be learned by doing! Start cracking, start experimenting, start having fun. Welcome to the future, that has just started.
![The World of the [open] innovator](https://publinova-harvester-content-acc.s3.amazonaws.com/thumbnails/files/previews/pdf/20240409032959354250.042ed686-762c-429d-ba80-1c82380cb051-thumbnail-400x300.png)
Sodium-glucose co-transporter 2 (SGLT2) inhibitors, including canagliflozin, reduce the risk of cardiovascular and kidney outcomes in patients with and without type 2 diabetes, albeit with a large interindividual variation. The underlying mechanisms for this variation in response might be attributed to differences in SGLT2 occupancy, resulting from individual variation in plasma and tissue drug exposure and receptor availability. We performed a feasibility study for the use of [18F]canagliflozin positron emission tomography (PET) imaging to determine the association between clinical canagliflozin doses and SGLT2 occupancy in patients with type 2 diabetes. We obtained two 90-minute dynamic PET scans with diagnostic intravenous [18F]canagliflozin administration and a full kinetic analysis in 7 patients with type 2 diabetes. Patients received 50, 100, or 300 mg oral canagliflozin (n = 2:4:1) 2.5 hours before the second scan. Canagliflozin pharmacokinetics and urinary glucose excretion were measured. The apparent SGLT2 occupancy was derived from the difference between the apparent volume of distribution of [18F]canagliflozin in the baseline and post-drug PET scans. Individual canagliflozin area under the curve from oral dosing until 24-hours (AUCP0-24h) varied largely (range 1,715–25,747 μg/L*hour, mean 10,580 μg/L*hour) and increased dose dependently with mean values of 4,543, 6,525, and 20,012 μg/L*hour for 50, 100, and 300 mg, respectively (P = 0.046). SGLT2 occupancy ranged between 65% and 87%, but did not correlate with canagliflozin dose, plasma exposure, or urinary glucose excretion. We report the feasibility of [18F]canagliflozin PET imaging to determine canagliflozin kidney disposition and SGLT2 occupancy. This suggests the potential of [18F]canagliflozin as a tool to visualize and quantify clinically SGLT2 tissue binding.
Background: During hospitalization patients frequently have a low level of physical activity, which is an important risk factor for functional decline. Function Focused Care (FFC) is an evidencebased intervention developed in the United States to prevent functional decline in older patients. Within FFC, nurses help older patients optimally participate in functional and physical activity during all care interactions. FFC was adapted to the Dutch Hospital setting, which led to Function Focused Care in Hospital (FFCiH). FFCiH consists of four components: (1) ‘Environmental and policy assessment’; (2) ‘Education’; (3) ‘Goal setting with the patient’ and (4) ‘Ongoing motivation and mentoring’. The feasibility of FFCiH in the Dutch hospital setting needs to be assessed. Objective: Introduce FFCiH into Dutch hospital wards, to assess the feasibility of FFCiH in terms of description of the intervention, implementation, mechanisms of impact, and context. Design: Mixed method design Setting(s): A Neurological and a Geriatric ward in a Dutch Hospital. Participants: 56 Nurses and nursing students working on these wards. Methods: The implementation process was described and the delivery was studied in terms of dose, fidelity, adaptions, and reach. The mechanisms of impact were studied by the perceived facilitators and barriers to the intervention. Qualitative data were collected via focus group interviews, observations, and field notes. Quantitative data were collected via evaluation forms and attendance/participation lists. Results: A detailed description of FFCiH in terms of what, how, when, and by whom was given. 54 Nurses (96.4%) on both wards attended at least 1 session of the education or participated in bedside teaching. The nurses assessed the content of the education sessions with a mean of 7.5 (SD 0.78) on a 0–10 scale. The patient files showed that different short and long-term goals were set. Several facilitators and barriers were identified, which led to additions to the intervention. An important facilitator was that nurses experienced FFCiH as an approach that fits with the principles underpinning their current working philosophy. The experienced barriers mainly concern the implementation elements of the FFCiH-components ‘Education’ and ‘Ongoing motivation and mentoring’. Optimizing the team involvement, improving nursing leadership during the implementation, and enhancing the involvement of patients and their family were activities added to FFCiH to improve future implementation. Conclusions: FFCiH is feasible for the Dutch hospital setting. Strong emphasis on team involvement, nursing leadership, and the involvement of patients and their families is recommended to optimize future implementation of FFCiH in Dutch hospitals.
