Open Access

Hypothesis/Aims of study Many results related to the effectiveness of surgical and non-surgical proce- dures for treating urinary incontinence (UI) are reported in the literature. Following the principles of evidence based-practice, besides the interpreta- tion of study results based on statistical significance, authors should consid- er evaluating the clinical relevance of treatment effects in this field. The minimal important difference (MID) of clinical outcomes could be used to assess the clinical relevance of interventions. MID is defined as “the small- est difference in score in the domain of interest that patients perceive as important, either beneficial or harmful, and which would lead the clinician to consider a change in the patient’s management’’[1]. One common way to obtain MID for outcomes of interest is by using anchor-based methods. These methods apply one anchor that analyzes the change in the patient's health status according to the patient’s perception. However, MIDs should be provided according to appropriate calculations and methods and based on the definition of a MID. However, there are a lot of misconceptions and misunderstandings related to the MID. These mis- understandings have led to incorrect reports of these values. Moreover, it is still not known which criteria the authors considered during the analysis of the MID in the Women’s Health area. Therefore, with this preliminary re- port, we aimed to identify and report all anchor-based methods to estimate MIDs for outcomes measures related to UI available in the literature; and analyze which concepts and levels of improvement in the health status of the patient have been considered by the authors to calculate the MID. Study design, materials and methods This systematic review was conducted according to PRISMA guide- lines. The study protocol was registered in the PROSPERO database (CRD42022299686). A systematic search was performed using Ovid Med- line, Embase, Web of Science, and Scopus from May to June 2021. Any study generating MIDs for UI that included women with more than 18 years, stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and/ or miXed urinary incontinence (MUI) was included. The primary outcome was the MID for outcomes related to UI. No limits were applied on the data- bases for the date, language or publication range. Studies were classified into three categories according to the level of im- provement in health status assessed by the anchor and considered by the authors during the MID calculation: 1) slight improvement: if authors in- cluded participants that evaluated their health status as “a little better” in their analysis; 2) moderate improvement: if authors considered women that reported a “better” or a “much better” status of the condition; or 3) strong imporvement: if all patients that improved (“very much better” or if authors grouped all the patients that improved in one single category) were consid- ered in one group against other group that did not report any improvement. After classifying the papers, we counted and reported how many studies were considering only the minimal level of improvement to reported the MID, according to previous definition and recommendation. The initial electronic search resulted in a total of 1,662. After removing du- plicates (n=719), 943 were screened, and at the end of the selection stages, nine papers that reported anchor-analysis were included in this preliminary report. Seven studies included women with SUI (total sample size= 2,436), while one study included only women with UUI (n=307), and the other one evaluated women with SUI and MUI (n=288). SiX studies analyzed data and provided the MID after a non-surgical treatment of UI, while three analyzed the results after surgery to correct UI. Eleven different questionnaires to measure the patient-related outcomes related to UI with their MIDs were identified. All the tools were related to measuring the impact, distress, or quality of life of women with UI. Different anchors were used to analyze MID, including scales that evaluated the improvement and satisfaction of the patient, and the visual analogue scale, measures of urinary leakage and questionnaires that measure the se- verity and impact of UI. The MID of siX tools was determined according to the smallest difference detected by the patients, using the Patient Global Im- pression of Improvement questionnaire and the self-reported satisfaction to assess the change of the condition. Most of the MIDs (n=28, 80%) were mis- calculated considering a moderate or a strong improvement of the patients, and not a minimal improvement as suggested by the literature (Table 1). Interpretation of results Although previous systematic reviews have reported the psychometric prop- erties of different questionnaires to measure UI outcomes, this is the first study to analyze methods of obtaining MIDs for UI outcomes from the pa- tients perspective (anchor based methods). All the tools with their respec- tives MIDs were related to the impact, distress, and/or quality of life of women with UI. The use of these outcomes measures is in line with the as- sociated impairments of social, psychological, financial, and sexual aspects of a women’s life produced by UI. Most of the authors in this field did not consider the smallest difference identified by the participants to calculate the MID, which does not follow the original definition of MID proposed by Jaeschke et al.,1 This could gen- erate underestimation or over-estimation of MID, which may directly im- pact the interpretation of the findings from the clinical trials[2] and biased interpretation of the results of the clinical significance from the interven- tions used to manage female UI. Therefore, the interpretation of the clinical significance related to UI outcomes should be done with caution. Concluding message Few studies that aimed to calculate the MID using anchor-based methods for outcomes related to female UI were found in the literature. Eleven different questionnaires to measure the outcomes related to UI with their MIDs were identified. However, most studies had not considered the smallest change of improvement (as perceived by the patients) in their analysis, which does not follow the definition of the MID. This could impact decision making. Future research should provide clear guidelines on how to calculate, report, and interpret MIDs in this field.

Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.

With the start of the 21st century, patient safety as a topic of special interest has attracted increasing attention in both academia and clinical practice. As technology has continued to develop since then, questions and focal points surrounding the topic have also shifted. In particular, questions regarding the impact of digitalization on patient safety and its measurement are now of high interest. This work aims to develop a maturity assessment instrument in the form of a criteria set for measuring structural requirements for digital patient safety in hospitals. Based on the results of a literature review and a derivation of maturity objects (MO) from known maturity models, 64 criteria across 11 categories were developed. Written comments of two digital patient safety experts as well as subsequent interviews were used to evaluate and refine the criteria catalog. The resulting catalog offers hospitals guidance for detecting possible areas of structural improvements in their information systems with regard to patient safety and represents a unique instrument for assessing digital maturity in this particular area.

Apps have been attested to empower patients regarding disease self-management through numerous studies. However, it is still unclear what factors determine the perception of patients whether an app is a useful tool for this purpose. A multiple regression model that was informed by the Technology Acceptance Model (TAM 2) was tested based on the answers of 235 app users with Diabetes type 1 or 2. The model accounted for 59.2% of the variance of the perceived degree of self-management. Factors belonging to the relevance-usefulness-quality complex as well as factors reflecting the patient’s self-control were found to be significant in the model. Patient demographics, i.e. age, gender, app experience and type of Diabetes did not play any significant role. In conclusion, this study raises the question whether apps should be designed to strengthen self-management in the sense of self-control (e.g. own measurements, diary) as opposed to guiding and advice giving.

Einleitung: Whiteboards können als ein Instrument des Lean Managements zur Steuerung der Verweildauer auf Stationen eingesetzt werden, um aktuelle Patienteninformationen zu bündeln und in regelmäßigen strukturierten sowie interdisziplinären Besprechungen die Patientenversorgung zu steuern, die interdisziplinäre Zusammenarbeit zu optimieren und das Entlassungsmanagement zu verbessern. Das Ziel dieser Studie bestand darin, zu untersuchen, inwiefern die Einführung von Whiteboards in zwei Kliniken mit einer Veränderung der Verweildauer einherging. Methode: Um die Forschungsfrage zu beantworten, wurden retrospektive Zeitreihen aus den DRG-Routinedaten vor und nach Installation der Whiteboards aus den beiden Kliniken in einem Interrupted Time Series Design genutzt. In der einen Klinik (Chirurgie) lagen 3.734 Fälle für den Zeitraum von Januar 2018 bis Dezember 2019 und in der anderen Klinik (Innere Medizin) 54.049 Fälle für den Zeitraum Juli 2013 bis Dezember 2019 vor. Ergebnisse: In dem gemittelten Vergleich der Verweildauer (relative Verweildauerabweichung pro DRG von dem jeweiligen Verweildauermittel) konnte in der ersten Klinik kein signifikanter Unterschied zwischen den Werten vor und nach Einführung des Boards festgestellt werden. Am zweiten Klinikum zeigte sich sogar im Vorher-Nachher-Vergleich eine signifikante Verschlechterung der Verweildauer. Eine deskriptive Zeitreihenanalyse vor und nach Einführung zeigte in beiden Kliniken, dass kurz nach der Einführung der Boards sich die Verweildauer verschlechterte, anschließend jedoch verbesserte, d.h. dass die Patienten durchschnittlich früher entlassen wurden. Dieser Unterschied ging jedoch im Zeitverlauf wieder zurück. Diskussion: Zusammenfassend lässt sich festhalten, dass keine Verbesserung in der Verweildauer im Zuge der Nutzung der Whiteboards durch einen reinen Vorher-Nachher-Vergleich nachweisbar war. In der anschließenden Zeitreihenbetrachtung zeigten sich starke Schwankungen, die zunächst mit einer kurzzeitigen Verschlechterung der Verweildauer nach der Implementierung einhergingen und dann zu einer Verbesserung führten. Im Zeitverlauf verblasste der Unterschied jedoch, sodass die Patienten wieder später entlassen wurden. Methodisch zeigt sich, dass im Gegensatz zu der reinen Vorher-Nachher-Analyse erst eine Zeitreihenbetrachtung einen Einblick in das Geschehen und seine Variabilität lieferte. Für die Praxis ergeben sich folgende Implikationen: Whiteboards können als ein hilfreiches Instrument von Lean Management zur Verweildauersteuerung angesehen werden, wie die zwischenzeitlichen Verbesserungen nahelegen. Dies erfordert jedoch eine kontinuierliche, unter Einbezug der Mitarbeiter durchgeführte Pflege der Informationen und einen erkennbaren Mehrwert. Perspektivisch empfiehlt sich zudem eine Digitalisierung der Boards, um den Nachteilen wie der manuellen Pflege entgegenzuwirken.

Rationale: Instrumentalists often suffer from playing-related (neuro-)musculoskeletal disorders (PRMDs). Most common PRMDs in string players are related to upper-body regions. Motion analysis has proven to be helpful in the evaluation of functional disorders. It was already shown that it is a valid and clinically feasible tool for accurate, repeatable, and objective assessments of functional movement in string players. Thus, it may guide clinicians to improvements in injury prevention, diagnosis, and treatment. Nevertheless, its application in clinical consultation is still very uncommon. For this reason, there is a lack of well-established motion analysis protocols for the examination of PRMDs in string players using advanced biomechanical instruments in clinical settings. Purpose: To demonstrate the development and application of a motion analysis protocol for the evaluation of functional upper-body movements in violinists, violists, and cellists in a clinical setting for the investigation of PRMDs. Approach: The protocol was to be integrated into a clinical reasoning process for testing clinical hypotheses and evaluating treatment outcomes in physiotherapy. As a starting point, a primary clinical question was defined, and then, specific upper-body symptom regions as well as measurement parameters (relative rotation angles and muscle activities over time) were identified. Subsequently, involved segments, joints, and muscles were assorted. For quantification of upper-body kinematics a novel, marker-based method was used which provides multi-segmented shoulder and spine models while providing simple application. Based on that, a comprehensive mechanical model of the upper body as well as the associated coordinate systems and rotation sequences were specified. This further guided both, the definition of a custom-made marker set as well as the selection and placement of surface electrodes. Furthermore, required static and functional calibration trials as well as movement tasks for functional assessment were specified. Finally, advanced approaches, such as a comprehensive kinematic model and functional determination of joint centers and axes were established for extraction. Then, outcome parameters and their form of representation were determined for further analysis and interpretation. The application of the method first includes the selection of segments, joints, and muscles to examine – originating from one or more clinical (working) hypotheses or symptom regions. This drives the configuration and placement of required surface markers and electrodes. Then, the required calibration and functional movement trials are executed. After measurement, the outcome parameters get extracted and analyzed. Based on the results the hypothesis is discarded or verified. Content: The method was applied to a violinist (female; 18 years old; 13 years of experience; practicing 2 to 3 hours per day, 7 days per week) with playing-related demands in the left cervical-shoulder-arm region. Subjective findings indicated that the pain regularly occurred after 30 minutes of playing fast or difficult musical pieces. Physical examination showed that strength testing of left serratus anterior muscle caused pain, lower trapezius muscles seemed weak, forearm muscles were sensitive to pressure, movement of the cervical spine to the left was reduced, and upper limb neural tension test was noticeable. This led to the following working hypothesis: Neck-related arm pain with neurodynamic component and motor control problem in the scapulothoracic region. Thus, left-sided cervical-shoulder-arm region was selected for functional examination. Optoelectronic motion capture system and surface electromyography were used for data collection. Static and function calibration trials as well as functional assessment trials (chromatic scale with different tempi) were conducted. Afterwards, data was further processed, and outcome parameters were extracted. Results showed that greater tempo and pain had an impact on the rotation angles and muscle activities. They led to less overall joint movement and range of motion, to less muscle activity in the forearm muscles, and to greater activity inputs in the scapulothoracic muscles. Overall, greater tempo and pain led to a different motor program which verified the working hypothesis. The procedure was repeated after treatment (four appointments over one week) with manual therapy, training, and education. The pre-/post-interventional comparison showed changes in the motor program. There was noticeable higher mean activity in upper trapezius and deltoid muscles and simultaneously less in the remaining ones. In addition, only marginal differences in ranges of motion and muscle activity inputs were found between tempi. The playing style appeared to be more stable now. Overall, it appeared that nearly the same motor program was used for each tempo. Clinical Implications: Potential applications are intraindividual evaluations of simultaneously joint and muscular function in string players during clinical consultation. It is intended to contribute to the diagnosis of PRMDs in terms of an objective, comprehensive and yet clinically feasible diagnostic assessment as well as pre-post-intervention outcome evaluation. Nonetheless, motion analysis must be used with care in clinical decision making. Motion data is subject to both, intraindividual variations, and measurement errors. In addition, the smallest clinically relevant changes are not clear yet. Therefore, results should only be interpreted together with other clinical findings.

Background and aims In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q. Methods In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools. Results The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%). Conclusions The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice. Implications Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.

Background This study describes a low-cost and time-efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST). Method Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non-specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated. Results Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind-up ratio) did not significantly correlate with QST. Conclusion Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low-cost screening tool in a clinical setting. Significance Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low-cost and time-efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.

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.

Führungskräfte in Nonprofit-Organisationen befinden sich in sich stetig wandelnden Handlungsfeldern. Damit sie in dieser Komplexität konstruktiv agieren können, sind Kompetenzen erforderlich: Ganz zentral ist die Fähigkeit, sich initiativ und eigenverantwortlich mit den Herausforderungen unserer Zeit auseinanderzusetzen und im besten Fall geeignete Lösungen dafür zu finden sowie diese zielführend kommunizieren zu können. Aus diesem Grund wird genau diese Fähigkeit bei Studierenden aus den Masterstudiengängen Management in Nonprofit-Organisationen und Soziale Arbeit der Hochschule Osnabrück gefördert. Im Rahmen des Moduls Handlungsfelder II entwickelten rund 30 Studierende im Wintersemester 2021/2022 in einer Denkwerkstatt Forschungsergebnisse und Lösungsideen zum Thema „Osnabrück 2030 – Nachhaltigkeit“. Die Studierenden wählten in einem partizipativen Prozess ihre eigenen Schwerpunktthemen wie zum Beispiel Mobilität oder Bildung aus und arbeiteten dann ein Semester lang an den Inhalten. Bei der Erarbeitung wurden sie durch Marlene Eimterbäumer begleitet, die Modelle, Methoden und Coaching zur Unterstützung bereit stellte. Die Modelle und Methoden finden sich teilweise in den Beiträgen der Studierenden wieder (unter anderem das Socio Ecological Model und der Business Model Canvas). Am Ende des Semesters stand eine Präsentation vor den Kommiliton*innen, der Lehrenden und auch vor externen Gästen, die aus unterschiedlichen Expertisegebieten im Themenbereich Nachhaltigkeit kamen und dementsprechend Feedback aus der Praxis geben konnten. Die Entwicklung des Moduls erfolgte durch Gesa Birnkraut und Marlene Eimterbäumer und wurde von der Hochschule im Rahmen der Innovativen Lehre an der Fakultät Wirtschafts- und Sozialwissenschaften gefördert. Für die Studierenden stellte das Modul durchaus eine Herausforderung dar, denn in der Denkwerkstatt musste unter hoher Komplexität stark prozessbezogen gearbeitet werden im Gegensatz zu der sonstigen hohen Ergebnisorientierung. Die durchweg sehr guten Ergebnisse zeigen, dass der Einsatz und die kontinuierliche Kommunikation und Zusammenarbeit gelohnt haben. Aufgeteilt ist das vorliegende Buch in die fünf Themen: Mobilität, nachhaltige Beschaffung, nachhaltige Bildung, Stadtplanung und Wirtschaft. Zu diesen Themen finden Sie jeweils erst einen Beitrag der Forscher*innen und darauffolgend einen Beitrag zur Darstellung einer Lösungsidee.

Die ethischen Fragen und Spannungsfelder individueller Förderung in inklusiven Schulen werden in der Ausbildung von Lehrkräften bisher nicht ausreichend behandelt. Gleichwohl wird erwartet, dass Lehrkräfte neben fachlichen und methodischen Kompetenzen auch ethische Kompetenzen in die Förderdiagnostik und das anschließende Fördervorgehen einbringen: Sie sollen ethische Implikationen ihrer Entscheidungen reflektieren, über eine wertebasierte Urteilsfähigkeit verfügen sowie Verantwortung für ihr pädagogisches Handeln übernehmen. Um diesen Anforderungen gerecht werden zu können, wird in diesem Beitrag für die Einführung einer ethischen Ausbildung angehender Lehrkräfte plädiert. Vorgestellt wird eine Modellkonzeption für zwei konsekutive Module im bildungswissenschaftlichen Anteil von Lehramtsstudiengängen, in denen Studierende eine Ethical Literacy in Bezug auf ihr förderpädagogisches Handeln in inklusiven Schulen erwerben.

Objectives Alexithymia, conceived as difficulties to identify emotions, is said to be related with several pain syndromes. This study examined the recognition of facially expressed emotions and its relation to alexithymia in subjects with chronic facial pain. Methods A total of 62 subjects were recruited, with n=20 patients with chronic facial pain and n=42 healthy controls. All subjects were tested for the recognition of facially expressed emotions (Facially Expressed Emotion Labelling Test (FEEL test). The Toronto Alexithymia Scale (TAS-26) was used for the diagnosis of alexithymia. Results Patients with chronic facial pain performed worse than controls at the FEEL task (p<.001) and showed higher total TAS scores (p<.001). This indicates the presence of alexithymia and facial emotion recognition deficits in the facial pain group. Discussion It was concluded from the results that both the recognition of facially expressed emotions, and the ability to identify and describe one’s own feelings (TAS), are restricted in chronic orofacial pain patients. This relationship is particularly important in the treatment of chronic facial pain, indicating that it should become part of the treatment in addition to the therapeutic key issues, to influence the quality of life of the affected patients positively.

Hintergrund Präventive Maßnahmen werden im Rahmen der Gesundheitsförderung immer bedeutsamer. Die regelmäßige Bewegung führt u. a. zu einer Stärkung des Herz-Kreislauf-Systems sowie zur Reduktion von muskuloskelettalen Beschwerden. Angestellte von Hochschulen sowie Studierende leiden häufig unter muskuloskelettalen Beschwerden. Ziel Ziel der Kundenbefragung ist es, die Zufriedenheit mit dem hochschulinternen Fitnessstudio INMOVE abzufragen, das rein physiotherapeutisch konzipiert ist. Mithilfe des Fragebogens sollen v. a. die Bereiche der Zufriedenheit, der physiotherapeutischen Betreuung sowie die subjektive Lebensqualität beurteilt werden. Methode Es wurde eine Kundenbefragung mit 26 Fragen, welche in vier Abschnitte eingeteilt sind, durchgeführt. Die geschlossenen Fragen wurden deskriptiv ausgewertet und die acht offenen Fragen wurden mit der Kernsatzmethode nach Leithäuser und Volmerg (1988) ausgewertet. Ergebnisse An der Befragung nahmen insgesamt 70 Trainierende (weiblich: 22/31,2 %, männlich: 48/68,8 %) teil. Anhand der Ergebnisse zeigt sich, dass die Teilnehmenden die Frage „Inwieweit sind die Kunden des hier genannten INMOVE mit dem Fitnessstudio zufrieden?“ mit „ziemlich zutreffend“ und „zutreffend“ beantworteten. Die zweite Forschungsfrage „Ist die physiotherapeutische Betreuung adäquat für das Fitnessstudio?“ kann mit „ziemlich zutreffend“ beantwortet werden. Die dritte Forschungsfrage bezog sich auf die Verbesserung der subjektiven Lebensqualität. Die Antwortenverteilung spiegelt, dass die Teilnehmenden diesen Themenbereich mit überwiegend „trifft genau zu“ oder „trifft ziemlich zu“ beantworteten. Schlussfolgerung Anhand der Kundenbefragung konnte die Zufriedenheit sowie die Auswirkungen auf die subjektive Lebensqualität beurteilt werden. Es lässt sich aus den Ergebnissen ableiten, dass ein hochschulinternes Fitnessstudio dabei helfen kann, Alltagsstress abzubauen und somit präventiv bei muskuloskelettalen Beschwerden nützlich ist.

Mit Einführung des § 2b UStG wurde die Unternehmereigenschaft der juristischen Personen des öffentlichen Rechts grundlegend geändert mit der Folge, dass sich der Anwendungsbereich der Umsatzsteuer für Finanzvorfälle der öffentlichen Hand erheblich ausgedehnt hat. Auch wenn damit die Aufwendungen dieser Organisationen in der Regel kostenneutral bleiben, ist durch die erweiterte Umsatzsteuerpflicht eine Verteuerung der Verwaltungsleistungen für die Bürger abzusehen. Für die Kommunen auf unterster Verwaltungsebene ist vor allem der Umgang mit der komplexen Rechtsmaterie eine große Zumutung, die sich auf Prozess- und Aufbauorganisation sowie auf die Verwaltungskultur auswirkt. Statt konkreter praktischer Hilfestellung, wird auf die nationale wie europäische Rechtsprechung und deren Auslegung verwiesen. Der Verlauf der aktuellen Corona-Pandemie hat den Hilferuf der Kommunen erneut in das Licht gerückt. Der Gesetzgeber gewährt der öffentlichen Verwaltung einen erneuten, nunmehr zweiten, Aufschub in Bezug auf eine rechtskonforme Umsetzung, die als Kernaufgabe eine Neubewertung aller Finanzvorfälle nach § 2b UStG vorsieht. Die Samtgemeinde Dörpen als Kooperationsbehörde hat den dringenden Handlungsbedarf erkannt und strebt einen Umsetzungsprozess bis zum 01.01.2023 an. Im Rahmen dieser Arbeit wird als individuelles Umsetzungskonzept für die Kooperationsbehörde eine digitale Vertragsdatenbank durch die zugrunde gelegte Methode der Dokumentenanalyse erstellt. Die angestrebte Lösung orientiert sich an der aktuellen Handlungsempfehlung eines Vertragsmanagements und der digitalen Schriftgutverwaltung als Ausfluss der Digitalisierung. Im Anschluss projiziert diese Arbeit die Erfahrungen und Umsetzungsergebnisse der Samtgemeinde Dörpen auf ein nach wie vor betrübtes Stimmungsbild der Neuregelungsfolgen aller Kommunen.

Guided by cultural labor economics, the paper analyzes the career paths of former actors from popular television soap operas, and addresses in particular, if and under which conditions such serial engagements may function as a stepping stone for a subsequent professional acting career. A novel database of 396 German artists with detailed and long-term biographical information is used for the quantitative empirical analyses. The results indicate that soaps, contrary to popular opinion, function as a stepping stone, especially for younger actors. However, soap engagements should be rather short but long enough to allow artists to play multiple roles in other shows or films besides being in the cast of a soap. While formal acting education does not influence soap actors’ future filmographies, there is evidence that it helps artists to find jobs in arts-related occupations such as voice acting. Finally, publicity and media presence foster a later acting career. Practical implications for artists and their managers are outlined, along with a discussion on the meaning of serials for the creation and commercialization of stars.

Objective: to carry out a theoretical reflection on the Nursing Now Campaign and the experience of the unexpected irruptions facing the pandemic period. Method: a theoretical-reflective study, supported by the theoretical framework of complexity thinking. It aims at understanding the dialogic between the notions of order, disorder and organization, which translate the transition from simplification to complexity of the pandemic phenomenon and its relation to the theme of Nursing Now and Nursing in the future. Results: the universe of phenomena is simultaneously composed of order, disorder and organization. Reasserting the central role of Nursing in the health team, facing the irruptions and uncertainties caused by the current pandemic, implies the ability to dialog with disorder and raise a new and more complex global (re)organization of the being and doing Nursing. Conclusion: in addition to answers, theoretical reflection raises new questions and irruptions. The inseparability between the notions of order and disorder in the evolutionary dynamics of the Nursing system is conceived and the promotion of even more complex levels of organization, management and Nursing assistance to achieve universal access to health is advocated.

BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking. OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility. STUDY DESIGN: Multicenter, prospective, cross-sectional design. SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany. METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale’s potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach’s alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity. RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories “no,” “mild,” “moderate,” and “severe.” The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale’s convergent validity). LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties. CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.

The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.

Objectives To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP). Design Case–control study. Setting Four private physiotherapy practices in northern Germany. Participants Consecutive males and females presenting to a physiotherapy clinic with non-specific LBP (n=65) were compared with 66 healthy-matched controls. Primary outcome measures Accuracy (sensitivity, specificity, Youden index, positive/negative likelihood ratio, area under the curve (AUC)) of a clinically driven consensus-based test battery including the ideal number of test items as well as threshold values and most accurate items. Results For both the two and three-level categorisation system, the ideal number of test items was 10. With increasing number of failed tests, the probability of having LBP increases. The overall discrimination potential for the two-level categorisation system of the test is good (AUC=0.85) with an optimal cut-off of three failed tests. The overall discrimination potential of the three-level categorisation system is fair (volume under the surface=0.52). The optimal cut-off for the 10-item test battery for categorisation into none, mild/moderate and severe MC impairment is three and six failed tests, respectively. Conclusion A 10-item test battery is recommended for both the two-level (impairment or not) and three-level (none, mild, moderate/severe) categorisation of patients with non-specific LBP.

Die Frage, ob Fachhochschulen ein Promotionsrecht erhalten sollen, hat weitreichende Folgen für die Hochschullandschaft und das Wissenschaftssystem in Deutschland.Prof. Dr. Nicolai Müller-Bromley, Präsident des Hochschullehrerbundes, nimmt zu dieser wissenschaftspolitischen Herausforderung Stellung und erläutert wichtige Argumente, die für ein Promotionsrecht von Fachhochschulen sprechen.

Hintergrund Mehr als die Hälfte aller schwangeren Frauen wird bereits zu einem frühen Zeitpunkt der Geburt in den Kreißsaal aufgenommen. Von Seiten der Frauen bestehen Unsicherheiten insbesondere darüber, ob die Geburt begonnen hat. Ist der Geburtsbeginn diagnostiziert und die Frau in den Kreißsaal aufgenommen, wird ein deutliches Voranschreiten der Geburt von Geburtshelferinnen und -helfern sowie den werdenden Eltern erwartet. Wissenschaftliche Evidenzen weisen auf einen Zusammenhang von früher Kreißsaalaufnahme und häufigeren Diagnosen von Geburtsdystokien und vermehrten Interventionen hin. In diesem Zusammen-hang wird darüber diskutiert, dass Frauen während der beginnenden Geburt möglicherweise nicht die optimale Betreuung erhalten. Die Forschenden fordern, Managemententscheidungen unter Berücksichtigung der Physiologie der Latenzphase und aktiven Geburtsphase aufeinander abzustimmen. Diese international übliche Unterteilung der ersten Geburtsphase erfährt in Deutschland eine zunehmende Aufmerksamkeit. Sie birgt die Chance, Frauen in der Latenzphase besser über den zu erwartenden Geburtsfortschritt aufzuklären, sie gezielter zu unterstützen und die Rate der diagnostizierten Geburtsdystokien zu reduzieren. Zielsetzung Der Einsatz eines selbstentwickelten Dokumentenformulars – Dokumentation Latenzphase – zur Diagnose des Geburtsbeginns und der Latenzphase und zur Unterstützung der klinischen Entscheidungsfindung von Hebammen1 in einem Hebammenkreißsaal, sollte das professionelle, abwartende Verhalten von Hebammen während der frühen Phase der Geburt fördern. Es wurde erwartet, dass die Berücksichtigung der Latenzphase und des damit verbundenen langsamen Geburtsfortschritts im Betreuungsprozess dazu führt, dass weniger Frauen während der Geburt vom Hebammenkreißsaal in den üblichen Kreißsaal weitergeleitet werden müssen. Zudem wurde eine nominelle Verlängerung der Dauer der dokumentierten Eröffnungsperiode erwartet. Methodik Die Wirkung der Dokumentation Latenzphase wurde in einer pragmatischen quasi-experimentellen Studie getestet. Hebammen des Hebammenkreißsaals der Interventionsklinik wurden zu Inhalt und Anwendung der Dokumentation Latenzphase geschult. In der Kontrollklinik wurden keine Änderungen an der Dokumentation der Betreuung vorgenommen, die Hebammen erhielten keine Schulung zur Latenz-phase und aktiven Geburtsphase. Für den Basisdatensatz wurden in der Interventionsklinik n = 137 Geburten vor Einführung der Intervention retrospektiv aus den Patientenakten erhoben. Im Interventionszeitraum wurden n = 147 Geburten dokumentiert. Zum Vergleich der Ergebnisse wurden insgesamt n = 183 Datensätze aus einer Kontrollklinik mit Hebammenkreißsaal herangezogen. Der Effekt wurde gemessen an der Häufigkeit, der vom Hebammenkreißsaal in den üblichen Kreiß-saal weitergeleiteten Geburten und der Dauer der dokumentierten Eröffnungsperiode. Weitere Outcomes betrafen die Anwendung von Oxytocin und Amniotomie und einer Schmerzbehandlung sowie von speziellen Betreuungsmaßnahmen von Hebammen. Explorative Analysen bezogen sich auf die Anwendung von medizinischen Maßnahmen in Abhängigkeit von der Geburtsphase (Latenzphase/aktive Geburtsphase) bei stationärer Aufnahme in der Interventionsklinik. Unterschiede wurden mithilfe von Chi2-Tests und Ereignisfunktionen ermittelt. Mögliche Einflüsse auf die Weiterleitung und Eröffnungsdauer wurden mit logistischen und Cox-Regressionen analysiert. Ergebnisse In beiden Kliniken werden keine signifikanten Veränderungen der Weiterleitung in den üblichen Kreißsaal vom Basis- zum Interventionszeitraum beobachtet. Entgegen dem Trend zu mehr Weiterleitungen von Erstgebärenden in der Kontrollklinik, blieb die Rate in der Interventionsklinik stabil. Die dokumentierte Dauer der Eröffnungsperiode stieg in der Interventionsklinik signifikant von durchschnittlich 6,00 auf 7,43 Stunden (p = 0,006). In der Kontrollklinik war keine Veränderungen nachzuweisen (5,19 vs. 4,89 Std.). Schlussfolgerungen Im Vergleich zur ansteigenden Weiterleitungsquote von Erstgebärenden in der Kontrollklinik und auf Basis der generell niedrigeren Weiterleitungsquote in der Interventionsklinik, ist die stabile Rate für Erstgebärende als Hinweis auf eine differenziertere Weiterleitungspraxis und ein stärker ausgeprägtes abwartendes Verhalten in der Interventionsklinik zu deuten. Die Verlängerung der Eröffnungsperiode zeigt auf, dass die Latenzphase über die Dokumentation Latenzphase erfolgreich in die Geburtszeit integriert wurde und Berücksichtigung fand.

INTRODUCCIÓN: Entre los actores del sistema de salud alemán, sólo los médicos y dentistas se formaron en las universidades. Desde enero 2020 está en vigor una nueva ley de partería que obliga a la formación de matronas en las universidades. Hasta ahora, las matronas han sido entrenadas tres años en escuelas vocacionales afiliadas a hospitales; el bachillerato no era un requisito previo. El pensamiento y el trabajo científico, así como la reflexión crítica sobre la propia práctica no formaban parte sistemáticamente del curriculo. Paralelamente a este sistema de entrenamiento, unas pocas ciudades alemanas han estado ensayando y evaluando cursos universitarios para matronas durante una década. En la realización práctica, la aplicación generalizada de la nueva ley representa un desafío. OBJETIVO: En esta comunicacíon se presentará el estado actual de la aplicación de la academización de las matronas en Alemania un año después de la promulgación de la nueva ley de partería. MATERIAL Y MÉTODO: Análisis de la situación con la ayuda de textos jurídicos, programas de estudio, artículos científicos, páginas web y entrevistas personales. RESULTADOS: El número de programas de estudio ya iniciados es menor que el número previsto originalmente. Los siguientes son factores que inhiben la rápida aplicación de la ley: el systema de federalismo en Alemania, la falta de matronas suficientemente cualificadas (doctorado) para el liderazgo de los cursos universitarios y para la docencia, las dudas extendidas en la profesión y entre otros actores de la atención de la salud y finalmente también las características del sistema de educación universitaria en Alemania. CONCLUSIONES: Cambiar la formación de una profesión es una tarea importante que conlleva desafíos. Los factores que dificultan la aplicación de la ley para las matronas en Alemania aún no han sido analizados sistemáticamente. Esto sería necesario para poder adoptar medidas específicas para promover la aplicación. Todavía queda mucho camino por recorrer antes de que la formación de las matronas en Alemania cambie realmente para mejor.

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.