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Institute
Als Jane mit ihrer kleinen Schwester tobt, schießt ihr plötzlich ein starker Schmerz in Nacken und Kopf. So weit nicht ungewöhnlich und eine Indikation für Physiotherapie. Doch als die junge Studentin erzählt, dass der Kopfschmerz pulsierend ist, wird ihr Therapeut hellhörig und stellt die entscheidenden Fragen.
Objective
To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT).
Methods
A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e-survey, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was posted using SurveyMonkey for each round. Percentages of responses were analysed for each question from each round of the Delphi survey administrations.
Results
Twenty-three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools and 3) physical examination tests. The following was the consensus-based decision regarding the identification of the clinically most useful assessments. (1) Four of 9 questionnaires were identified: Jaw Functional Limitation (JFL-8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD) and the neck disability index (NDI). (2) Three of 8 identified pain screening tests: visual analog scale (VAS), numeric pain rating scale (NRS) and pain during mandibular movements. (3) Eight of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine and the Neck Flexor Muscle Endurance Test.
Conclusion
After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity) and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research.
The Brief Symptom Inventory (BSI)-18 is a widely-used tool to assess changes in general distress in patients despite an ongoing debate about its factorial structure and lack of evidence for longitudinal measurement invariance (LMI). We investigated BSI-18 scores from 1,081 patients from an outpatient clinic collected after the 2nd, 6th, 10th, 18th, and 26th therapy session. Confirmatory factor analysis (CFA) was used to compare models comprising one, three, and four latent dimensions that were proposed in the literature. LMI was investigated using a series of model comparisons, based on chi-square tests, effect sizes, and changes in comparative fit index (CFI). Psychological distress diminished over the course of therapy. A four-factor structure (depression, somatic symptoms, generalized anxiety, and panic) showed the best fit to the data at all measurement occasions. The series of model comparisons showed that constraining parameters to be equal across time resulted in very small decreases in model fit that did not exceed the cutoff for the assumption of measurement in variance. Our results show that the BSI-18 is best conceptualized as a four-dimensional tool that exhibits strict longitudinal measurement invariance. Clinicians and applied researchers do not have to be concerned about the interpretation of mean differences over time.
Seit Jahren ist die steuerliche Behandlung von Aufwendungen für ein häusliches Arbeitszimmer ein immer wiederkehrendes Thema in der Fachliteratur. Auch zahlreiche Auseinandersetzungen mit dem Finanzamt resultieren aus der (Nicht-)Berücksichtigung dieser Aufwendungen. In der Vergangenheit wurden bereits etliche Gerichtsurteile zu unterschiedlichen Fallkonstruktionen aus diesem Bereich gesprochen. Momentan hat das Thema erneut an Aktualität gewonnen. So arbeitet aufgrund der derzeit herrschenden Pandemie eine große Anzahl an Steuerpflichtigen (erstmals) im Homeoffice und wendet sich ratsuchend mit Fragen zu den entsprechenden steuerlichen Folgen an ihre steuerlichen Berater. Der vorliegende Beitrag beschäftigt sich unter Heranziehung einschlägiger Urteile mit der steuerlichen Behandlung von Aufwendungen für ein häusliches Arbeitszimmer, nimmt Stellung zu den Möglichkeiten der steuerlichen Abzugsfähigkeit in der aktuellen besonderen Situation, analysiert diese kritisch und formuliert konkrete Handlungsempfehlungen.
Die Geschichte von »Wellness« lässt sich lange zurückverfolgen. Der Artikel stellt einige Eckpfeiler dieser bewegten Geschichte dar. Aufgezeigt wird vor allem, wie »Wellness« gerade im deutschsprachigen Raum auf offene Ohren stieß und wie der Begriff durch eine hemmungslose Kommerzialisierung seinen ursprünglichen Bedeutungsgehalt veränderte.
Background
Against the background of a steadily increasing degree of digitalization in health care, a professional information management (IM) is required to successfully plan, implement, and evaluate information technology (IT). At its core, IM has to ensure a high quality of health data and health information systems to support patient care.
Objectives
The goal of the present study was to define what constitutes professional IM as a construct as well as to propose a reliable and valid measurement instrument.
Methods
To develop and validate the construct of professionalism of information management (PIM) and itsmeasurement, a stepwise approach followed an established procedure from information systems and behavioral research. The procedure included an analysis of the pertaining literature and expert rounds on the construct and the
instrument, two consecutive and comprehensive surveys at the national and international level, exploratory and confirmatory factor analyses as well as reliability and validity testing.
Results
Professionalism of information management was developed as a construct consisting of the three dimensions of strategic, tactical, and operational IMas well as of the regularity and cyclical phases of IM procedures as the two elements of professionalism.
The PIM instrument operationalized the construct providing items that incorporated IM procedures along the three dimensions and cyclical phases. These procedures had to be evaluated against their degree of regularity in the instrument. The instrument proved to be reliable and valid in two consecutive measurement phases
and across three countries.
Conclusion
It can be concluded that professionalism of information management is a meaningful construct that can be operationalized in a scientifically rigorous manner. Both science and practice can benefit from these developments in terms of improved self-assessment, benchmarking capabilities, and eventually, obtaining a better understanding of health IT maturity.
Injection of slurry or digestate below maize seeds is a relatively new technique developed to improve nitrogen use efficiency. However, this practice has the major drawback of increasing nitrous oxide (N2O) emissions. The application of a nitrification inhibitor (NI) is an effective method to reduce these emissions. To evaluate the effect of the NI 3,4‐dimethypyrazole phosphate (DMPP) on N2O emissions and the stabilization of ammonium, a two‐factorial soil‐column experiment was conducted. PVC pipes (20 cm diameter and 30 cm length) were used as incubation vessels for the soil‐columns. The trial consisted of four treatments in a randomized block design with four replications: slurry injection, slurry injection + DMPP, digestate injection, and digestate injection + DMPP. During the 47‐day incubation period, N2O fluxes were measured twice a week and cumulated by linear interpolation of the gas‐fluxes of consecutive measurement dates. After completion of the gas flux measurement, concentration of ammonium and nitrate within the soil‐columns was determined. DMPP delayed the conversion of ammonium within the manure injection zone significantly. This effect was considerably more pronounced in treatment digestate + NI than in treatment slurry + NI. Regarding the cumulated N2O emissions, no difference between slurry and digestate treatments was determined. DMPP reduced the release of N2O significantly. Transferring the results into practice, the use of DMPP is a promising way to reduce greenhouse gas emissions and nitrate leaching, following the injection of slurry or digestate.
Background/Aim
This study aimed to establish the somatosensory profile of patients with lumbar radiculopathy at pre-and post-microdiscectomy and to explore any association between pre-surgical quantitative sensory test (QST) parameters and post-surgical clinical outcomes.
Methods
A standardized QST protocol was performed in 53 patients (mean age 38 ± 11 years, 26 females) with unilateral L5/S1 radiculopathy in the main pain area (MPA), affected dermatome and contralateral mirror sites and in age- and gender-,and body site-matched healthy controls. Repeat measures at 3 months included QST, the Oswestry Disability Index (ODI) and numerous other clinical measures; at 12 months, only clinical measures were repeated. A change <30% on the ODI was defined as ‘no clinically meaningful improvement’.
Results
Patients showed a significant loss of function in their symptomatic leg both in the dermatome (thermal, mechanical, vibration detection p < .002), and MPA (thermal, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p < .041) and increased cold sensitivity in the MPA (p < .001). Pre-surgical altered QST parameters improved significantly post-surgery in the dermatome (p < .018) in the symptomatic leg and in the MPA (p < .010), except for thermal detection thresholds and cold sensitivity. Clinical outcomes improved at 3 and 12 months (p < .001). Seven patients demonstrated <30% change on the ODI at 12 months. Baseline loss of function in mechanical detection in the MPA was associated with <30% change on the ODI at 12 months (OR 2.63, 95% CI 1.09–6.37, p = .032).
Conclusion
Microdiscectomy resulted in improvements in affected somatosensory parameters and clinical outcomes. Pre-surgical mechanical detection thresholds may be predictive of clinical outcome.
Significance
This study documented quantitative sensory testing (QST) profiles in patients with lumbar radiculopathy in their main pain area (MPA) and dermatome pre- and post-microdiscectomy and explored associations between QST parameters and clinical outcome. Lumbar radiculopathy was associated with loss of function in modalities mediated by large and small sensory fibres. Microdiscectomy resulted in significant improvements in loss of function and clinical outcomes in 85% of our cohort. Pre-surgical mechanical detection thresholds in the MPA may be predictive of clinical outcome.
Wir kennen neurodynamische Tests und Behandlungsmethoden, nutzen diese alltäglich in der Praxis und gehen auf Kurse, um mehr darüber zu lernen. Aber was verstehen wir tatsächlich darunter? Kommen wir in unserem Verständnis darüber auf einen gemeinsamen Nenner? Dieser Artikel gibt einen Einblick in die Thematik Neurodynamik. Bisherige Überzeugungen stehen dabei auf dem Prüfstand.
Nervenschmerz ist nicht gleich Nervenschmerz. Um Patienten mit ausstrahlenden Schmerzen, bei denen die Nerven eine Rolle spielen könnten, adäquat zu therapieren, sind eine gründliche Untersuchung und ein fundiertes Clinical Reasoning unerlässlich. Nur dadurch entpuppen sich die beiden Patientinnen mit fast identischen Symptomen als sehr unterschiedlich.
In diesem erfahrungsbasierten Artikel geht es um die praktische Anwendung von Recovery-Strukturen-Setting und den Versuch, das Potenzial von Recovery für den rehabilitativen Bereich der Psychiatrie herauszustellen. Darüber hinaus wird weiterer Forschungsbedarf dargestellt. Hintergrund ist ein zehnwöchiges Praktikum in einer Tagesklinik in der Schweiz.
Quantitative Umweltbewertungen sind von entscheidender Bedeutung, wenn es darum geht, effektiv auf nachhaltige Produktions- und Verbrauchsmuster hinzuarbeiten. In den letzten Jahrzehnten haben sich Lebenszyklusanalysen (LCA) als praktikables Mittel zur Messung der Umweltauswirkungen von Produkten entlang der Lieferkette etabliert. In Bezug auf Nutzer- und Konsummuster wurden jedoch methodische Schwächen festgestellt, und es wurden mehrere Versuche unternommen, Ökobilanzen entsprechend zu verbessern, beispielsweise durch Einbeziehung von Effekten höherer Ordnung und verhaltenswissenschaftlicher Unterstützung. In einer Diskussion solcher Ansätze zeigen wir, dass den Konzepten des Verbrauchs keine explizite Aufmerksamkeit geschenkt wurde, was häufig zu produktzentrierten Bewertungen führt. Wir führen Theorien sozialer Praktiken ein, um Konsummuster für LCA zugänglich zu machen. Soziale Praktiken sind routinierte Handlungen, die aus miteinander verbundenen Elementen (Materialien, Kompetenzen und Bedeutungen) bestehen, die sie als eine Einheit denkbar machen (z. B. Kochen). Da die meisten sozialen Praktiken eine Art von Verbrauch (Material, Energie, Luft) beinhalten, konnten wir einen Rahmen entwickeln, der soziale Praktiken mit der Ökobilanz verbindet. Der vorgeschlagene Rahmen bietet eine neue Perspektive für quantitative Umweltbewertungen, indem er den Schwerpunkt von Produkten oder Nutzern auf soziale Praktiken verlagert. Dementsprechend sehen wir die Chance darin, die reduktionistische Sichtweise zu überwinden, dass Menschen nur Nutzer von Produkten sind, und sie stattdessen als Praktiker in sozialen Praktiken zu sehen. Dieser Wandel könnte neue Methoden der interdisziplinären Konsumforschung ermöglichen, die beabsichtigte Sozialwissenschaften und wirkungsorientierte Bewertungen einbeziehen. Allerdings bedarf der Rahmen einer weiteren Überarbeitung und vor allem einer empirischen Validierung.
Editorial
(2020)
Lückenlose Versorgung
(2020)
IT-Standard für das pflegerische Entlassmanagement.
Der von der Hochschule Osnabrück entwickelte „ePflegebericht“ kann die bisherigen unterschiedlichen papierbasierten Überleitungen ablösen, indem die entsprechenden IT-Systeme interoperabel Dokumente austauschen. Die Pflege erhält mit diesem IT-Standard erstmals einen möglichen Zugang zur Telematikinfrastruktur, um zwischen Einrichtungen und über Sektorengrenzen hinweg pflegerisch relevante Informationen schnell und sicher zu übermitteln.
Ecological restoration of an urban demolition site through introduction of native forb species
(2020)
Urban brownfields can provide habitats for endangered native plant species but may also support invasive non native species. The aim of our study was to develop and test different measures for the ecological restoration of an urban brownfield. We aimed to enhance native plant species richness by seeding two native forb seed mix tures containing 25 (HD-mixture) and 13 species (LD-mixture), respectively, without affecting spontaneously colonizing plant species of nature conservation value. Additionally, we tested the effects of species introduction and mowing on the establishment of invasive non-native plant species, woody species development, and per ennial grass dominance.
With establishment rates of 84% (HD) and 92% (LD) in the first study year and about 60% for both seed mixtures in the fourth year, species introduction was successful and led to rapid re-vegetation of the formerly bare brownfield. Although seeding did not result in increased species richness using either seed mixture, the dominance of perennial grasses was significantly reduced by the establishment of forb species from the HD mixture. Overall, we observed the spontaneous establishment of ten plant species of conservation value; seeding affected these species only temporarily, in the second year. Seeding (with either seed mixture) and mowing both resulted in reduced cover of woody species and a lower frequency of the invasive non-native Robinia pseudoa cacia.
Our study demonstrated the high nature conservation value of dry and nutrient-poor urban brownfields for spontaneously occurring threatened plant species. Further studies have to evaluate if the reduced cover of grasses and woody species through introduction of site-specific native forb species might increase these sites’ aesthetic value and broader acceptance of brownfields by urban residents.
Extensive green roofs (EGRs) offer several beneficial ecosystem services for sustainable urban development. However, most standard green roofs have been designed with species-poor plant mixtures containing non-native species. Aiming to increase the nature conservation values of EGRs, we developed and tested a vascular plant seed mixture including regionally occurring native sandy dry grassland species in experimental miniature roofs in Northwestern Germany (temperate oceanic climate) over 4 years. We tested the mixture at two seed densities (1 and 2 g/m2). Additionally, we tested seeding at 1 g/m2 and introducing raked plant material collected from an ancient dry grassland. The total establishment rates of sown species reached 92–96% in the first year, but dropped to 40–60% in the last 2 years, with the highest values for the plots with raked material. Twenty-four additional species (11 vascular, 7 lichen, and 6 moss species, including 7 red-list species) typical of sandy dry grasslands were introduced through the raked material. Vascular plants reached 60–70% cover in the second year. Severe drought periods in the third and the fourth year led to a strong decline of vascular plant cover then. As this cover was higher in the plots with raked material, we assume facilitative effects through the well-developed cryptogam layer containing a mix of pleurocarpous and acrocarpous mosses and lichens. Spontaneously establishing acrocarpous mosses in sown plots did not seem to provide this same function. We conclude that EGRs designed with regionally occurring sandy dry grassland plant species and especially the application of raked plant material from ancient grassland is a fruitful approach to increase the value of green roofs for native phytodiversity.
Within the frame of the EU Common Agricultural Policy, most countries subsidise the establishment and maintenance of perennial flower strips on arable land within Agri-Environmental Schemes to provide foraging habitats and refuges for wildlife.
In a replicated field experiment, we studied the effects of different types of seed mixtures on the establishment and maintenance of perennial flower strips on fertile arable land in the federal state of Saxony-Anhalt, Germany over seven years. The seed mixtures were commonly applied within recent Common Agricultural Policy funding periods: (1) a low-diversity cultivar standard seed mixture (CULTIVAR), (2) a high-diversity cultivar and native plant mixture (MIX), and (3) a high-diversity native plant mixture (WILDFLOWER). All plots were mulched every year in March and at the beginning of August.
The low success of CULTIVAR triggered the massive encroachment of spontaneously established perennial grasses. In MIX, too, cultivars have disappeared after the first year. Both wildflower variants were successful in maintaining a high cover of sown perennial native forbs and a high ratio of established sown species, even after seven years. WILDFLOWER always tended to show better values than MIX. Furthermore, spontaneously establishing species began to spread their cover in MIX in the fifth year, with a very strongly increasing tendency, whereas in WILDFLOWER cover of spontaneously immigrating species stayed satisfyingly low.
Using native wildflowers to establish perennial wildflower strips was very effective in maintaining high species diversity within the Agri-Environmental Schemes funding period of five years and beyond. WILDFLOWER was especially successful. On the other hand, CULTIVAR failed completely. On fertile soils in regions with rather low yearly precipitation, mulching twice a year supported the maintenance of perennial wildflower strips.
Entrapment neuropathies such as carpal tunnel syndrome, radiculopathies, or radicular pain are the most common peripheral neuropathies and also the most common cause for neuropathic pain. Despite their high prevalence, they often remain challenging to diagnose and manage in a clinical setting. Summarising the evidence from both preclinical and clinical studies, this review provides an update on the aetiology and pathophysiology of entrapment neuropathies. Potential mechanisms are put in perspective with clinical findings. The contemporary assessment is discussed and diagnostic pitfalls highlighted. The evidence for the noninvasive and surgical management of common entrapment neuropathies is summarised and future areas of research are identified.
Entrapment neuropathies are a heterogenous condition reflecting distinct underlying pathomechanisms. A contemporary assessment aimed at identifying potential mechanisms may help target management for these patients.
Virtuelle Führung Wie Vertrauensaufbau und Informationsaustausch in virtuellen Teams gelingen
(2020)
Der Beitrag geht der Frage nach, wie eine vertrauensvolle Zusammenarbeit mit der Ausgestaltung interprofessioneller Kooperationen von Lehr- und Fachkräften in Grundschulteams zusammenhängt. Zunächst wird die Bedeutung von Vertrauen in der Zusammenarbeit als Voraussetzung für interprofessionelle Kooperation behandelt und anschließend durch die Darstellung und Diskussion quantitativer Ergebnisse eines Forschungs- und Entwicklungsprojektes zur interprofessionellen Kooperation in inklusiven Grundschulen konkretisiert. Die Studienergebnisse zeigen, dass die befragten Lehr- und Fachkräfte (n=208) enger und intensiver zusammenarbeiten, je stärker das Vertrauensniveau im Kollegium ausgeprägt ist. Schlussfolgernd sollten Fort- und Weiterbildungsangebote für Lehr- und Fachkräfte inklusiver Grundschulen auch die Entwicklung, Aufrechterhaltung und Intensivierung einer vertrauensvollen interprofessionellen Kooperation unterstützen.
Postbürokratische Organisationsformen spielen im Zuge der Digitalisierung, Globalisierung sowie des demographischen und gesellschaftlichen Wandels eine aktuelle und zunehmend wichtige Rolle. Der Büroraum kann in dieser Hinsicht einen wesentlichen Beitrag zur Förderung interpersoneller Kommunikation, als Rahmenbedingung neuer Organisationsformen, leisten. Dennoch wird dem Büroraum in Wissenschaft und Praxis bislang ein geringer Stellenwert zugeschrieben. In Folge einer Literaturstudie zeigt dieser Beitrag, inwiefern Kommunikation und Büroarchitektur zusammenhängen und was daher bei der Einführung von Büroformen zu beachten ist. Der Beitrag liefert dadurch Anregungen und Orientierung für das Kommunikationsmanagement.
Eine Nackenflexion beeinflusst nachweislich die Mechanosensibilität von neurodynamischen Testungen der unteren Extremität. In der Literatur wird diskutiert, ob sich dieses Phänomen durch eine erhöhte (intraneurale) Spannung des Nervengewebes und/oder einen protektiven Reflexmechanismus des motorischen Systems erklären lässt. Bislang konnte kein protektiver Mechanismus in Form einer modifizierten muskulären Rekrutierung als mechanosensibler Parameter zwischen der passiven Nackenflexion und der unteren Extremität gemessen werden.
Alle in diese Querschnittsstudie eingeschlossenen 30 asymptomatischen, männlichen Probanden führten den neurodynamischen Straight-Leg-Raise-Test und Slump-Test durch. Um einen möglichen Einfluss der passiven Nackenflexion auf die muskuläre Rekrutierung der unteren Extremität festzustellen, wurden während dieser sensibilisierenden Bewegung die muskuläre Rekrutierung und das Bewegungsausmaß mittels Elektromyografie und Inertialsensorik (kinematische Messtechnik) gemessen.
Die Studienergebnisse bestätigten einen segmentübergreifenden Einfluss der passiven Nackenflexion auf die muskuläre Rekrutierung der unteren Extremität. Deren Muster deuten möglicherweise auf einen protektiven muskulären Mechanismus in endgradigen neurodynamischen Positionen hin.
Objectives
The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.
Setting
University-initiated international survey.
Participants
The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.
Procedures
The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools.
Results
Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.
Conclusions
Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication.
Background: In aged nursing care receivers, the prevalence of adverse skin conditions such as xerosis cutis, intertrigo, pressure ulcers or skin tears is high. Adequate skin care strategies are an effective method for maintaining and enhancing skin health and integrity in this population.
Objectives: The objective was to summarize the empirical evidence about the effects and effectiveness of non-drug topical skin care interventions to promote and to maintain skin integrity and skin barrier function in the aged, to identify outcome domains and outcome measurement instruments in this field.
Design: An update of a previous systematic review published in 2013 was conducted.
Data sources: Databases MEDLINE and EMBASE via OvidSP and CINAHL (original search January 1990 to August 2012, update September 2012 to May 2018) and reference lists were searched. Forward searches in Web of Science were conducted.
Methods: A review protocol was registered in Prospero (CRD42018100792). Main inclusion criteria were primary intervention studies reporting treatment effects of basic skin care strategies in aged people with a lower limit of age range of 50 years and published between 1990 and 2018. Primary empirical studies were included with experimental study designs including randomized controlled trials and quasi-experimental designs. Methodological quality of included randomized controlled trials was evaluated using the Cochrane Collaboration's Tool for assessing risk of bias. Levels of evidence were assigned to all included studies.
Results: Sixty-three articles were included in the final analysis reporting effects of interventions to treat and/or to prevent skin dryness, pruritus, general skin barrier improvement, incontinence-associated dermatitis, skin tears and pressure ulcers. Skin cleansers containing syndets or amphotheric surfactants compared with standard soap and water improved skin dryness. Lipophilic leave-on products containing humectants decreased skin dryness and reduced pruritus. Products with pH 4 improved the skin barrier. Application of skin protectants and structured skin care protocols decreased the severity of incontinence-associated dermatitis. Formulations containing glycerin and petrolatum reduced the incidence of skin tears. Thirty-five outcome domains were identified with nearly 100 different outcome measurement instruments.
Conclusion: Included studies showed substantial heterogeneity regarding design, interventions and outcomes. Basic skin care strategies including low-irritating cleansers and lipophilic humectant-containing leave-on products are helpful for treating dry skin and improving skin barrier in the aged. Lower pH of leave-on products improves the skin barrier. The number of different outcome domains was unexpectedly high. We recommend to identify critical outcome domains in the field of skin care to make trial results more comparable in the future and to measure possible performance differences between different skin care strategies and products.
Various overoxidized poly(1H-pyrrole) (PPy), poly(N-methylpyrrole) (PMePy) or poly(3,4-ethylenedioxythiophene) (PEDOT) membranes incorporated into an acrylate-based solid polymer electrolyte matrix (SPE) were directly electrosynthesized by a two-step in situ procedure. The aim was to extend and improve fundamental properties of pure SPE materials. The polymer matrix is based on the cross-linking of glycerol propoxylate (1PO/OH) triacrylate (GPTA) with poly(ethylene glycol) diacrylate (PEGDA) and lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) as a conducting salt. A self-standing and flexible polymer electrolyte film is formed during the UV-induced photopolymerization of the acrylate precursors, followed by an electrochemical polymerization of the conducting polymers to form a 3D-IPN. The electrical conductivity of the conducting polymer is destroyed by electrochemical overoxidation in order to convert the conducting polymer into an ion-exchange membrane by introduction of electron-rich groups onto polymer units. The resulting polymer films were characterized by scanning electron microscopy, cyclic voltammetry, electrochemical impedance spectroscopy, differential scanning calorimetry, thermal analysis and infrared spectroscopy. The results of this study show that the combination of a polyacrylate-matrix with ion selective properties of overoxidized CPs leads to new 3D materials with higher ionic conductivity than SPEs and separator or selective ion-exchange membrane properties with good stability by facile fabrication.
Die öffentlich-rechtlichen Medienanstalten spielen rechtlich wie wirtschaftlich eine besondere Rolle im deutschen Mediensystem. Verhandlungen um Sport-Übertragungsrechte stehen vor diesem Hintergrund und in Anbetracht der Preise für die Lizenzpakete stets unter medialer Beobachtung.
Von kommunikationswissenschaftlichem Interesse ist deshalb, wie sich die Öffentlich-Rechtlichen in Deutschland in einer solchen Diskussion präsentieren und welchen Einfluss sie tatsächlich auf die Medienberichterstattung ausüben können. Als Fallbeispiel dienen in diesem Beitrag die Verhandlungen um die Olympia-Übertragungsrechte 2018 bis 2024. Auf der theoretischen Grundlage des Framings nach Robert Entman wurde ein inhaltsanalytisches Instrumentarium angewendet, mit dem sich strategische wie mediale Deutungsmuster offenlegen lassen. Es zeigte sich, dass ARD und ZDF über alle Phasen der Verhandlungen hinweg in der Lage waren, die Aussagen ihrer Sprecher in den Berichten zu positionieren.
Aus diesen Erkenntnissen ließen sich im Kern drei Ableitungen für die Kommunikationsarbeit der Öffentlich-Rechtlichen treffen. Erstens sollten sie sich ihrer außergewöhnlichen Kommunikatorposition bewusst sein. Außerdem sollten sie diese Position nutzen, um medial noch mehr zu agieren statt zu reagieren. Im Kontext von Sportrechteverhandlungen sollten sie zudem den Aspekt des verantwortungsvollen Umgangs mit Gebührengeldern stärker betonen.
Model-derived relationships between chlorophyll a (Chl-a) and nutrients and temperature have fundamental implications for understanding complex interactions among water quality measures used for lake classification, yet accuracy comparisons of different approaches are scarce. Here, we (1) compared Chl-a model performances across linear and nonlinear statistical approaches; (2) evaluated single and combined effects of nutrients, depth, and temperature as lake surface water temperature (LSWT) or altitude on Chl-a; and (3) investigated the reliability of the best water quality model across 13 lakes from perialpine and central Balkan mountain regions. Chl-a was modelled using in situ water quality data from 157 European lakes; elevation data and LSWT in situ data were complemented by remote sensing measurements. Nonlinear approaches performed better, implying complex relationships between Chl-a and the explanatory variables. Boosted regression trees, as the best performing approach, accommodated interactions among predictor variables. Chl-a–nutrient relationships were characterized by sigmoidal curves, with total phosphorus having the largest explanatory power for our study region. In comparison with LSWT, utilization of altitude, the often-used temperature surrogate, led to different influence directions but similar predictive performances. These results support utilizing altitude in models for Chl-a predictions. Compared to Chl-a observations, Chl-a predictions of the best performing approach for mountain lakes (oligotrophic–eutrophic) led to minor differences in trophic state categorizations. Our findings suggest that both models with LSWT and altitude are appropriate for water quality predictions of lakes in mountain regions and emphasize the importance of incorporating interactions among variables when facing lake management challenges.
Die folgende Studie wurde vor dem Hintergrund der zunehmenden Relevanz von ökologisch nachhaltigem Handeln in unserer Gesellschaft aufgrund von wachsenden erlebbaren Auswirkungen durch unsere Lebensweise und den Klimawandel durchgeführt. Für die folgende qualitative Studie wurden fünf Studierende und fünf Berufstätige zu den Hintergründen ihres ökologisch nachhaltigen Handelns befragt. Es wurden zehn Einflussfaktoren identifiziert, welche ökologisch nachhaltiges Handeln von Studierenden und Berufstätigen beeinflussen: Wissen & Informationen; Persönliche Relevanz; empfundene Wichtigkeit & Interesse; Erlebnisse & Erfahrungen (auch ehrenamtliches Engagement); Soziale Umfelder (persönliches, studentisches und berufliches Umfeld); Beeinflussung durch Andere (auch Beeinflussung durch Medien); Positiver Nutzen; Abwägung; Gewohnheiten; Gefühle; Möglichkeiten zur Umsetzung. Als theoretische Basis zur Untersuchung von beeinflussenden Faktoren wurde das psychologische Modell zur Erklärung nachhaltigen Handelns von Hamann, Baumann und Löschinger (2016) hinzugezogen. Des Weiteren wurden drei Aspekte zur positiven Auswirkung von ökologisch nachhaltigem Handeln zur Förderung ökologisch nachhaltigen Handelns in der Gesellschaft gefunden: fortlaufender Prozess; Beeinflussung von Anderen; Ideen zur Förderung von ökologisch nachhaltigem Handeln. Weitere Maßnahmenvorschläge und Handlungsempfehlungen wurden v. a. für die Kontexte Beruf, Studium, Schule und Medien aus den Erkenntnissen der Studie abgeleitet.
In der Corona-Pandemie ist es für nahezu alle Organisationen – von der Behörde, über die Unternehmung, bis hin zur Hochschule – zur Aufgabe geworden, den „richtigen“ Umgang mit der Krise zu finden. Was effektives Krisenmanagement ausmacht, soll deshalb vor dem Hintergrund des aktuellen Standes der Fachdiskussion beleuchtet und für eine Selbstreflexion aufbereitet werden, wie sie im Rahmen eines dualen Studiengangs eingeübt und im Sinne einer persönlichen Kompetenzentwicklung vertieft werden kann.
Die Gesundheits- und Kinderkrankenpflege ist ein grundlegender Bestandteil der Netzwerke „Früher Hilfen“, wenn es darum geht, Familien in herausfordernden sozialen und gesundheitlichen Lagen in der Häuslichkeit zu unterstützen. Dieses Arbeitsfeld ist für die Kinderkrankenpflege neu. Die dort stattfindenden Prozesse der Etablierung und deren Auswirkungen auf die Professionsentwicklung sind Forschungsgegenstand dieser Arbeit. Ziel ist es, die Situation der Gesundheits- und Kinderkrankenpflege im Arbeitsfeld Frühe Hilfen im Hinblick auf Professionalisierung und Professionalität zu analysieren. Dazu findet die Situationsanalyse als Weiterentwicklung der Grounded Theory Anwendung. In diesem Beitrag werden die Theoriebezüge und Methoden der Situationsanalyse von Clarke (2012; 2018) vor diesem Forschungshintergrund dargestellt. Anhand des Analyseprozesses werden die Mappingstrategien als Werkzeug der Situationsanalyse erläutert und beispielhaft veranschaulicht. Der methodische Zugewinn durch die Situationsanalyse für den Forschungsgegenstand wird diskutiert. Die Relevanz der Grounded Theory und der Situationsanalyse für die Pflegewissenschaft werden zusammenfassend erörtert.
Abstract
Background
The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time.
Method
We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course.
Conclusion
The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.