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Institute
Purpose
Differences between standard dysarthria treatment and the same treatment with the integration of neurodynamic techniques tailored to the severity of dysarthria in patients with Parkinson's disease were examined.
Method
In total, 10 subjects with idiopathic Parkinson's disease and rigid–hypokinetic dysarthria were enrolled in this quasi-randomized, controlled, single-blind, pre–post study. In each of 12 therapy sessions the control group (n = 5) received standard dysarthria treatment (usual care), while the intervention group (n = 5) received the same treatment with the addition of integrated neurodynamic treatment (special care).
Results
There was no significant difference between the two groups for either the pre-test (p = 0.739) or the post-test (p = 0.156) results. However, significant differences between the pre-test and post-test results within each group (intervention group p = 0.001; control group p = 0.003) were found.
Conclusions
The significant differences in the pre–post comparison within the groups may indicate a high probability of a positive effect of standard dysarthria treatment on the severity of dysarthria. In between-group comparisons, the study results indicated no evidence of a significant difference between standard dysarthria treatment with or without neurodynamics. Due to the small sample size, the effectiveness of the integration of neurodynamics into speech therapy cannot be definitively concluded for now. In order to be able to have generalized applicability, future studies with larger numbers of participants are required.
Objectives
To investigate differences in pressure pain thresholds (PPTs) and longitudinal mechanosensitivity of the greater occipital nerve (GON) between patients with side-dominant head and neck pain (SDHNP) and healthy controls. Evaluation of neural sensitivity is not a standard procedure in the physical examination of headache patients but may influence treatment decisions.
Methods
Two blinded investigators evaluated PPTs on two different locations bilaterally over the GON as well as the occipitalis longsitting-slump (OLSS) in subjects with SDHNP (n = 38)) and healthy controls (n = 38).
Results
Pressure pain sensitivity of the GON was lower at the occiput in patients compared to controls (p = 0.001). Differences in pressure sensitivity of the GON at the nucheal line, or between the dominant headache side and the non-dominant side were not found (p > 0.05). The OLSS showed significant higher pain intensity in SDHNP (p < 0.001). In comparison to the non-dominant side, the dominant side was significantly more sensitive (p = 0.004).
Discussion
Palpation of the GON at the occiput and the OLSS may be potentially relevant tests in SDHNP. One explanation for an increased bilateral sensitivity may be sensitization mechanisms. Future research should investigate the efficacy of neurodynamic techniques directed at the GON.
Objectives: The aims of this study were to define the Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) scores associated with no pain, mild pain, moderate pain, and severe pain in children with acute pain, and to identify differences based on age, sex, and ethnicity.
Methods: We conducted a prospective observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions. We assessed their pain intensity using the FPS-R, CAS, and qualitative measures. Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic-based method. Cut points were compared within subgroups based on age, sex, and ethnicity.
Results: We enrolled 620 patients, of whom 314 had painful conditions. The mean age was 9.2 years; 315 (50.8%) were in the younger age group (aged 4-7 years); 291 (46.8%) were female; and 341 (55%) were Hispanic. The scores best representing categories of pain for the FPS-R were as follows: no pain, 0 and 2; mild pain, 4; moderate pain, 6; and severe pain, 8 and 10. For the CAS, these were 0 to 1, 1.25 to 2.75, 3 to 5.75, and 6 to 10, respectively. Children with no pain frequently reported nonzero pain scores. There was considerable overlap of scores associated with mild and moderate pain. There were no clinically meaningful differences of scores representing each category of pain based on age, ethnicity, and race.
Conclusions: We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics. There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention.
The Liebowitz Social Anxiety Scale (LSAS) is the most frequently used instrument to assess social anxiety disorder (SAD) in clinical research and practice. Both a self‐reported (LSAS‐SR) and a clinician‐administered (LSAS‐CA) version are available. The aim of the present study was to define optimal cut‐off (OC) scores for remission and response to treatment for the LSAS in a German sample.
Data of N = 311 patients with SAD were used who had completed psychotherapeutic treatment within a multicentre randomized controlled trial. Diagnosis of SAD and reduction in symptom severity according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, served as gold standard. OCs yielding the best balance between sensitivity and specificity were determined using receiver operating characteristics. The variability of the resulting OCs was estimated by nonparametric bootstrapping.
Using diagnosis of SAD (present vs. absent) as a criterion, results for remission indicated cut‐off values of 35 for the LSAS‐SR and 30 for the LSAS‐CA, with acceptable sensitivity (LSAS‐SR: .83, LSAS‐CA: .88) and specificity (LSAS‐SR: .82, LSAS‐CA: .87). For detection of response to treatment, assessed by a 1‐point reduction in the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition, rating, a reduction of 28% for the LSAS‐SR and 29% for the LSAS‐CA yielded the best balance between sensitivity (LSAS‐SR: .75, LSAS‐CA: .83) and specificity (LSAS‐SR: .76, LSAS‐CA: .80).
To our knowledge, we are the first to define cut points for the LSAS in a German sample. Overall, the cut points for remission and response corroborate previously reported cut points, now building on a broader data basis.
Small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia
(2018)
Background:
Chemotherapy-induced Peripheral Neuropathy (CIPN) of large-fibers affects up to 20% of survivors of pediatric acute lymphoblastic leukemia (ALL). We aimed to describe small-fiber toxicity and pain sensitization in this group.
Methods:
In a cross-sectional, bicentric study we assessed 46 survivors of pediatric ALL (Mean age: 5.7 ± 3.5 years at diagnosis, median 2.5 years after therapy; males: 28). Inclusion criteria: ≥6 years of age, ≥3 months after last administration of Vincristine, and cumulative dose of Vincristine 12 mg/m2. We used a reduced version of the Pediatric-modified Total Neuropathy Score (Ped-mTNS) as bedside test and Quantitative Sensory Testing (QST) for assessment of small- and large-fiber neuropathy as well as pain sensitization. We employed Nerve Conduction Studies (NCS) as the most accurate tool for detecting large-fiber neuropathy.
Results:
Fifteen survivors (33%) had abnormal rPed-mTNS values (≥4 points) and 5 survivors (11%) reported pain. In QST, the survivor group showed significant (p < 0.001) inferior large-fiber function and pain sensitization when compared to healthy matched peers. We identified deficits of vibration in 33 (72%) and tactile hypoesthesia in 29 (63%), hyperalgesia to blunt pressure in 19 (41%), increased mechanical pain sensitivity in 12 (26%) and allodynia in 16 (35%) of 46 survivors. Only 7 survivors (15%) had pathologic NCS.
Conclusion:
QST is a sensitive tool that revealed signs of large-fiber neuropathy in two thirds, small-fiber neuropathy and pain sensitization in one third of survivors. Prospective studies using QST in pediatric oncology may help to elucidate the pathophysiology of small-fiber neuropathy and pain sensitization as well as their relevance for quality of survival.
Objective:
The German version of the Social Phobia and Anxiety Inventory (SPAI-G) is avalidated measure for the detection of social anxiety disorder (SAD). The aim of the presentstudy was to develop optimal cut points (OC) for remission and response to treatment for theSPAI-G.
Methods:
We used Receiver Operating Characteristic methods and bootstrapping to analysethe data of 359 patients after psychotherapeutic treatment. OCs where defined as the cut pointswith the highest sensitivity and specificity after bootstrapping.
Results:
For remission, an OC of 2.79 was found, and for response, a change in score frompre- to posttreatment by 11% yielded best results.
Conclusions:
The OC we identified for remission may be used to improve the diagnostic utilityof the SPAI-G. However, the cut point for response achieved only borderline-acceptable levelsof sensitivity and specificity, calling into doubt their utility in clinical and research setting.
Introduction:
Many patients with cerebral palsy (CP) suffer chronic pain as one of the most limiting factors in their quality of life. In CP patients, pain mechanisms are not well understood, and pain therapy remains a challenge. Quantitative sensory testing (QST) might provide unique information about the functional status of the somatosensory system and therefore better guide pain treatment.
Objectives:
To understand better the underlying pain mechanisms in pediatric CP patients, we aimed to assess clinical and pain parameters, as well as QST profiles, which were matched to the patients' cerebral imaging pathology.
Patients and methods:
Thirty CP patients aged 6–20 years old (mean age 12 years) without intellectual impairment underwent standardized assessments of QST. Cerebral imaging was reassessed. QST results were compared to age- and sex-matched controls (multiple linear regression; Fisher's exact test; linear correlation analysis).
Results:
CP patients were less sensitive to all mechanical and thermal stimuli than healthy controls but more sensitive to all mechanical pain stimuli (each p < 0.001). Fifty percent of CP patients showed a combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia; 67% of CP patients had periventricular leukomalacia (PVL), which was correlated with mechanic (r = 0.661; p < 0.001) and thermal (r = 0.624; p = 0.001) hypoesthesia.
Conclusion:
The combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia in our CP patients implicates lemniscal and extralemniscal neuron dysfunction in the thalamus region, likely due to PVL. We suspect that extralemniscal tracts are involved in the original of pain in our CP patients, as in adults.
How do companies decide where to locate their manufacturing? This study uses insights from manufacturing company executives collected by means of in-depth interviews with 50 manufacturers in the United Kingdom to develop an understanding of manufacturing location decision making. The findings indicate that companies derive competitive advantage from organizing manufacturing in different ways. Retaining or reshoring manufacturing to a company’s home country can enhance new product development, control of quality, product customization, delivery performance, and cost leadership. On the other hand, companies can enhance new product development, customization, and delivery performance for new markets, if production facilities are offshored to or in proximity to these locations. In addition, some companies use a hybrid approach of offshoring the production of some components or products for cost arbitrage while retaining or reshoring other components or products for advantages from value chain integration. Based on the findings of this study, a set of key manufacturing location questions are developed that should be considered by firms pondering onshore, offshore, reshore, or hybrid manufacturing location decisions.
Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework.
Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings.
Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics.
Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas.
Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.
Current frameworks postulate the success of health IT innovations to be determined by the professionalism of the information management (PIM). Still, empirical knowledge about PIM is scarce up until today. This study seeks to answer three research questions: (1.) How can PIM be measured in a reliable and valid way, (2.) how pronounced is PIM in German hospitals and (3.) do hospital characteristics have an impact on the degree of PIM? Based on the results of an expert workshop and frameworks for information management (IM) items for a PIM inventory were developed and the inventory sent to 1349 chief information officers of German hospitals. A principle component analysis based on the responses of 196 hospitals confirmed the three components that had been proposed by the frameworks: the strategic, the tactical and the operational level. The full inventory implied satisfying reliability and allowed a PIM composite-score to be calculated. The PIM scores for strategic and tactical IM were found to be far lower than for operational IM which hints at strong deficits in these areas. A stepwise regression model indicated that the degree of PIM significantly increased with the size of the hospital, which had been expected and hints the validity of the PIM inventory. This tool offers potentials for hospitals to classify and improve their IM.
Going Mobile : An Empirical Model for Explaining Successful Information Logistics in Ward Rounds
(2018)
Background: Medical ward rounds are critical focal points of inpatient care that call for uniquely flexible solutions to provide clinical information at the bedside. While this fact is undoubted, adoption rates of mobile IT solutions remain rather low.
Objectives: Our goal was to investigate if and how mobile IT solutions influence successful information provision at the bedside, i.e. clinical information logistics, as well as to shed light at socio-organizational factors that facilitate adoption rates from a user-centered perspective.
Methods: Survey data were collected from 373 medical and nursing directors of German, Austrian and Swiss hospitals and analyzed using variance-based Structural Equation Modelling (SEM).
Results: The adoption of mobile IT solutions explains large portions of clinical information logistics and is in itself associated with an organizational culture of innovation and end user participation.
Conclusion: Results should encourage decision makers to understand mobility as a core constituent of information logistics and thus to promote close end-user participation as well as to work towards building a culture of innovation.
The workflow-oriented dissemination of electronic patient data is a central goal of IT deployment in hospitals. Against this background, the present study examines two research questions: (1.) Are there differences in the availability of electronic patient data (AEPD) between different clinical workflows and data types and (2.) which structural and organizational factors determine AEPD? Based on a Germany wide hospital survey, AEPD was assessed along six clinical workflows. While AEPD was lowest for ward rounds, discharge showed the highest AEPD with pre- and post-surgery processes ranging in between. With regard to the data types analyzed, patient demographics and observation findings obtained the highest AEPD scores. Electrophysiological results, checklists and warnings were less common electronically and received lower AEPD scores. Multiple linear regression analysis resulted in a significant model that explained 34.4% of the variance of AEPD. Large hospitals and those with a professional information management, a high health IT related innovation culture and a nursing informatics officer possess higher AEPD scores and thus have better clinical information logistics mechanisms at their command.
Health IT systems are employed to support continuity of care via information continuity, while management continuity is often neglected. This study aims at investigating issues of management continuity when developing a collaborative decision support system for chronic wounds. Thirty-three experts from a variety of professions and disciplines discussed problems and possible solutions in four workshops. The following topics emerged from the discussion: existing networks involving payers, responsibilities as well as good discharge management. These topics clearly address management continuity and are also relevant for the scenario of inter-professional wound care across different settings.
The establishment of successful clinical information logistics (CIL) within the care processes is one of the main objectives of strategic health IT management in hospitals. While technical realisations in terms of useful, usable and interoperable IT solutions are essential precursors of CIL, there is limited empirical research on what socio-organisational factors underlie an innovation-friendly culture and how they can affect successful information provision. We applied factor analysis on survey data from 403 clinical directors from Germany, Austria and Switzerland and used the dimensions identified to explain the level of CIL with ordered logistic regression analysis. The intensity of collaboration and exchange with the IT department as well as the degree of executive IT leadership showed to be strongly associated with better CIL while personal views and attitudes of clinical directors were not. Analysing country differences revealed the degree of the exchange with the IT department to be significantly lower in German hospitals. This points at a potential strategic lever for German hospital executives to focus on.
This prospective longitudinal study aims at better understanding eHealth success factors in different European nations, esp. the role of eHealth-legislation in Switzerland and Germany. Qualitative interviews with 39 matched experts from a large variety of institutions in both nations were conducted. The individual statements in the interviews and the overall satisfaction rating indicate a clear trend for a more optimistic attitude towards the law in Switzerland than in Germany. This result is not surprising given the history of a telematics infrastructure in Germany. Cross-country learning topics for German politicians are the inclusion of the inpatient sector and the focus on one major application. In a next step, interview results from Austria will be included and with that the scope of study findings enriched.
Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.
As health IT supports processes along the entire patient trajectory and involves different types of professional groups, eHealth is inter-professional by nature. The aim of this study, therefore, is to investigate which competencies are at the intersection of the individual groups of health professionals. 718 international experts provided relevance ratings of eHealth competencies for different professional roles in an online survey. Communication and leadership proved to be important competencies across all professions, not only for executives. None or very little differences between professions were found between physicians and nurses, between IT experts at different levels and between IT experts and executives. However, there were a number of competencies rated differently when contrasting direct patient care specialists with executives. These findings should encourage organisations issuing educational recommendations to specify areas of shared competencies more extensively.
Making solar thermal systems less expensive, often results in a lower system efficiency. However, the cost-benefit ratio is relevant from the perspective of the consumer. The complex impact of component-related and system-related design parameters on the economics of a complete system makes the evaluation and economical optimization difficult.
Therefore, a complete simulation environment has been developed, which can automatically optimize solar-thermal systems,including collector and system parameters. The main collector module consists of a one-dimensional thermal model that was validated with a commercial solar collector. The efficiency curve and the production cost werecalculated as a function of several design and construction parameters. The collector module was linked to the commercial software Polysun®, so that parametric studies can be performed with minimaleffort. Optimization problems can be solved by using the Matlab® optimization toolbox.
The simulation environment wasused for sensitivity studies and optimization problems in order to analyze the impact of collector design-parameters with respect to system cost, system yield andeconomic values. We will demonstrate how a collector can be optimized and how the ideal system parameters like collector number and storage volume can be easily calculated. Finally, we will show how the optimizer is used for a given system in order to find ideal values for the absorber-sheet thickness and the number of pipes. Due to the holistic approach, the application of this tool set can be used for collector development as well as for system planning.
Background
Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.
Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.
Methods
The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.
Results
The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.
Conclusions
The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.
This paper introduces and empirically illustrates a pedagogical approach to teaching Public Relations (PR) in higher education. The approach is based on the Communities of Practice theory (Wenger, 1998). Based on this theory and for the purposes of this paper, learning is perceived as (1) a participation in a practice of (2) a social community and (3) the understanding of this practice. The pedagogical approach to teaching PR entails the facilitation of these three elements. The approach is illustrated through a case study. The authors conducted an international undergraduate course to teach students how to conduct a social media campaign to raise engagement for social issues. Twenty students from Netherlands and Germany enrolled. The paper offers an integrated understanding of theory and practice (see Wenger, 1998, p. 48). It contrasts many current approaches in PR education, which tend to differentiate between PR theory and practice. PR educators are encouraged to facilitate an equal negotiation between theory and practice and to enable students to match whatever is theorised with practice and whatever is practiced with theory.