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Over the past decade, the proliferation of entrepreneurial ventures and small firms with sustainable business models have pushed the sustainability agenda in the fashion industry. Despite prominent success stories, these companies often encounter significant operative challenges that hinder growth or even cause business failure. This paper adopts a qualitative research design and uses data gathered during 18 expert interviews with entrepreneurs and executive managers of 18 firms from 13 countries to identify and explore the dominant challenges that micro- and small-sized sustainable fashion companies struggle with. The results indicate that communicating with consumers is perceived as surprisingly difficult, especially because sustainable brands need to justify higher prices and explain the added benefits of their products. Second, resource constraints lead to operative friction and overburdening of the decision makers and their small management teams. Third, sustainable sourcing and production processes are economically difficult in an industry that continues to occupy a mass and low-cost logic. Against the background of these insights, a range of managerial recommendations are developed and contextualized in the framework of the Business Model Canvas. This novel approach makes the suggestions which are rooted in the resource-based view actionable and supports sustainable businesses to better manage their operations and achieve growth. For example, collaborative approaches with different stakeholders may mitigate constraints across all three identified problem areas.
Information systems (IS) play a central role in promoting corporate sustainability and pro-environmental behavior. This study explores the use of mobile apps for fostering sustainability-oriented corporate culture. It accentuates issues relating to sustainability-oriented corporate culture (RQ1), app meta-requirements as a strategic approach to addressing these issues (RQ2), as well as design and implementation principles (RQ3). Referring to the literature on sustainability apps, gamification, and nudging, our qualitative research design combines an analysis of four corporate apps intending to promote sustainable behavior and expert interviews (Grounded Theory). The proposed framework supports the planning, realization, and monitoring of this targeted app use. Single cultural dimensions inform seven issues in culture development. Five meta-requirements address this multi-dimensionality, challenges provided by new digital working environments, and principles of Green IT. Four design principles support, extend, and integrate current knowledge on app features, nudging, and gamification. Five variables determine the app intervention and maturity level. We conclude that this targeted app use should intend to foster the sustainability orientation within all dimensions of corporate culture instead of being limited to promoting sustainable behavior.
rationale: Musculoskeletal problems are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related musculoskeletal problems. In order to provide a specific physiotherapeutic management for performing artists, it is important to gain information about the performing art, the individual (biomechanical) demands and contributing factors. The subjective examination is the basis of the clinical reasoning process and the hypothesis forming, which is important for goal setting in further clinical examination and biomechanical analysis. In the present protocol, the subjective examination consists of a questionnaire based section and an interview based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: The aim of this study was to develop a standardized protocol for an interview based subjective examination of performing artists with musculoskeletal problems. The results of this section of the subjective examination will be combined with the results of the questionnaire based subjective examination , in order to gather as much relevant information as possible to specifically address the individual’s musculoskeletal health status.
methods: A common physiotherapeutic recording of findings which addresses the relevant questions of the subjective examination of musculoskeletal problems was used. In order to adapt the anamnesis to performing-related musculoskeletal problems, questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
results: The protocol is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. (2017) .The performing art specific questions especially address (1) performing art specific considerations including style, genre, education and professional level, practice habits, repertoire, and external factors, e.g. concert conditions, (2) performing art specific physical and psychosocial contributing factors, and (3) performing art specific activities which trigger the musculoskeletal problems and help to form hypotheses for the following clinical examination. Individual tracks lead through the subjective examination so that irrelevant questions are skipped depending on the kind of musculoskeletal problem and the performing art practiced by the individual client.
conclusions: A pretest of this standardized anamnesis protocol is ongoing in a special physiotherapy clinic for performing artists since spring 2022. In an iterative approach, the protocol will be continuously improved based on patient feedback and clinical considerations.
Hintergrund
Negatives Geburtserleben steht im Verdacht mit nachfolgender Sterilität, einem längeren Abstand zum nächsten Kind, sowie dem Wunsch nach einer primären Sectio bei einer weiteren Schwangerschaft assoziiert zu sein. Die derzeitige Datenlage ist kontrovers.
Methodisches Vorgehen
Das Design entspricht einer explorativen, qualitativen Querschnittsstudie. Dazu wurden zehn leitfadengestützte Interviews nach dem Prinzip des Problemzentrierten Interviews durchgeführt. Eingeschlossen wurden Primiparae, die vor dem 11.03.2020 (vor den Einschränkungen der Covid-19-Pandemie) geboren haben. Die Interviews wurden nach der inhaltlich strukturierenden qualitativen Inhaltsanalyse nach Kuckartz analysiert.
Ergebnisse
Insbesondere Frauen mit negativem Geburtserleben tendieren zu einer abgeschwächten Bereitschaft für eine weitere Schwangerschaft, dazu keine weitere Schwangerschaft zu planen sowie einen längeren Abstand zu einer weiteren Schwangerschaft zu wahren. Nur in Einzelfällen kann bei Frauen mit positiver Geburtserfahrung eine verstärkte Bereitschaft für eine weitere Schwangerschaft festgestellt werden. Die Entscheidung bezüglich der Planung einer Schwangerschaft ist multifaktoriell und sowohl vom Geburtserleben als auch von persönlichen, medizinischen, familiären und finanziellen Aspekten abhängig.
Diskussion
Besonders das Auftreten medizinischer Besonderheiten, das negative Erleben des Geburtsmodus, der peripartalen Schmerzen sowie der Betreuung und Versorgung scheinen Einflussfaktoren zu sein, welche die Bereitschaft für die Planung einer weiteren Schwangerschaft abschwächen. Es besteht weiterer Forschungsbedarf durch quantitative Arbeiten und in der Begriffsdefinition von Geburtserleben.
Fazit
Das individuelle Geburtserleben von Primiparae kann einen Einfluss auf die Planung einer weiteren Schwangerschaft haben.
Der Beitrag analysiert den Umgang mit der Covid-19-Pandemie innerhalb der Krankenhäuser und leitet davon Handlungsempfehlungen für das Krankenhausmanagement ab. Dabei geht es sowohl um die Organisation und Ausgestaltung der Patienten- und Personalsteuerung (vorgelagerte Notaufnahmen, Aufnahmestationen, Triage, Covid-19-Testung etc.) als auch um die sich durch die Kontaktbeschränkung ergebene Herausforderung im Umgang mit Besuchern und Lieferanten. Des Weiteren wird auch die betriebswirtschaftliche Steuerung in einer – in allen Belangen – ungewohnten Situation beleuchtet.
Freshwater ecosystems host disproportionately high numbers of species relative to their surface area yet are poorly protected globally. We used data on the distribution of 1631 species of aquatic plant, mollusc, odonate and fish in 18,816 river and lake catchments in Europe to establish spatial conservation priorities based on the occurrence of threatened, rangerestricted and endemic species using the Marxan systematic conservation planning tool. We found that priorities were highest for rivers and ancient lakes in S Europe, large rivers and lakes in E and N Europe, smaller lakes in NW Europe and karst/limestone areas in the Balkans, S France and central Europe. The a priori inclusion of well-protected catchments resulted in geographically more balanced priorities and better coverage of threatened (critically endangered, endangered and vulnerable) species. The a priori exclusion of well-protected catchments showed that priority areas that need further conservation interventions are in S and E Europe. We developed three ways to evaluate the correspondence between conservation priority and current protection by assessing whether a cathment has more (or less) priority given its protection level relative to all other catchments. Each method found that priority relative to protection was high in S and E Europe and generally low in NW Europe. The inclusion of hydrological connectivity had little influence on these patterns but decreased the coverage of threatened species, indicating a trade-off between connectivity and conservation of threatened species. Our results suggest that catchments in S and E Europe need urgent conservation attention (protected areas, restoration, management, species protection) in the face of imminent threats such as river regulation, dam construction, hydropower development and climate change. Our study presents continental-scale conservation priorities for freshwater ecosystems in ecologically meaningful planning units and will thus be important in freshwater biodiversity conservation policy and practice, and water management in Europe.
Hintergrund: In Deutschland beginnen 96,6% der Frauen nach der Geburt ihr Kind zu stillen, nach den ersten vier Lebensmonate werden jedoch nur 55,8% der Neugeborenen ausschließlich gestillt (vgl. Kersting et al. 2020). Viele Mütter überwinden trotz hoher Stillmotivation die ersten Stillschwierigkeiten bei der Etablierung des Stillens nicht (vgl. Rasenack et al. 2012; Weissenborn et al. 2016). Es besteht also Forschungsbedarf, wie Mütter Stillschwierigkeiten erleben und überwinden, um zu ergründen, wie sie beim Stillen unterstützt werden können.
Zielsetzung & Methodik: Zur Beantwortung der Forschungsfrage „Wie werden Stillschwierigkeiten aus der Perspektive von erststillenden Müttern erlebt und bewältigt?“ wurde ein qualitativer Forschungsansatz gewählt. Über das Projekt „Stillförderung im Landkreis und der Stadt Osnabrück“ konnten 11 Frauen für ein halbstrukturiertes, problemzentriertes Interview nach Witzel gewonnen werden. Die Mütter wurden einzeln und retrospektiv 4 - 11 Monate nach der Geburt befragt. Ausgewertet wurden die erhobenen Daten wurden mit der qualitativen Inhaltsanalyse nach Mayring.
Ergebnisse: Das Erleben von Stillschwierigkeiten ist ein sehr emotionales und komplexes, teils widersprüchlich empfundenes Thema. Sie geht einher mit der Erfahrung nicht erfüllter Erwartungen, extremer Schmerzen und dem Aufkommen von teils konträren Gefühlen. Die Still- und Ernährungssituation des Kindes bestimmen den Alltag und werden als zeitaufwändig und unpraktisch erlebt. Beim Erreichen der emotionalen Belastungsgrenze machen sich Mütter Gedanken über das Abstillen. An diesem Punkt empfinden sie eine große Diskrepanz zwischen der eigenen hohen Stillmotivation und der selbst erlebten Stillunfähigkeit. Für die Bewältigung von Stillschwierigkeiten spielen eine hohe Stillmotivation und bestimmte Charaktereigenschaften wie Durchhaltevermögen eine wichtige Rolle. Mütter wenden in der Stillsituation verschiedene Bewältigungsstrategien an, um proaktiv und lösungsorientiert mit dieser umgehen zu können. Schmerzen werden ertragen und negative Gefühle überwunden durch eine innere Distanzierung.
Fazit: Die erhobenen Ergebnisse werden durch bereits vorhandene Studien belegt. Aus den Ergebnissen lassen sich konkrete Handlungsempfehlungen für Stillberatungen ableiten.
Background:
Neck pain is one of the most common musculoskeletal pains and among the fourth leading causes of years of life lost due to disability, following back pain, depression, and arthralgia. (1)
In the course of their lives, about 70% of all people will experience a clinically relevant episode of neck pain, (2) so finding a good therapy to treat it is of high interest. Aerobic exercise is associated with pain reduction in patients with different types of MSK pain. Recent studies have shown a positive impact of aerobic exercises on brain function, memory processing, cognition, and motor function. (3, 4)
Therefore, the influence of aerobic exercise on pain modulation seems to be of particular interest for individuals with chronic MSK pain, since brain imaging studies have shown that these patients have structural and functional changes, as well as abnormal brain features in various areas of the brain. The evidence regarding the effectiveness of aerobic exercise for neck pain seems limited and outdated.
Thus, a systematic review evaluating the effects of aerobic exercise in patients with neck pain is needed. Therefore, this review aims to investigate the effectiveness of aerobic exercise interventions when compared to other conservative and non-conservative interventions (e.g., localized exercises, medication, acupuncture, physical agents, manual therapy) to decrease pain intensity in people with neck pain.
Materials and methods:
Electronic literature searches were conducted in a total of six databases such as Medline, Embase, CINAHL, Cochrane Library, Web of Science, and Scopus. The review considered randomised controlled trials (RCTs) including patients over 18 years having musculoskeletal pain in the neck area. The Neck Pain Task Force's classification of pain severity describes four levels of neck pain, with the first three levels considered in this review. (5)These must be clinically diagnosed by a health care provider according to signs and symptoms or based on standardized criteria specific for each disease. Studies involving subjects with any pre-existing conditions, previous surgery, or pain not clearly related to the musculoskeletal system were excluded. No limits were applied in terms of sex, ethnicity, and living country. Data were extracted using a standardized data extraction form.
Methodological quality was determined using the Cochrane Collaboration Risk of Bias Tool (CCRBT) and the strength of the evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and evaluated by two independent reviewers.
Results:
A total of 21585 records were identified and screened independently for eligibility by two reviewers. A total of six unique studies, reported on ten manuscripts met the specified inclusion criteria. Different types of aerobic exercise were used in the studies. Studies included isolated and combined aerobic exercise using interventions such as cycling on an ergometer or walking outdoors at a moderate intensity. Comparison groups were for example strength training or education. The most common outcome was pain assessed with the Visual Analogue Scale (VAS) or the Nordic questionnaire.
The included studies had a high risk of bias and the overall quality of the evidence for this systematic review was considered low. There was high heterogeneity in the included studies regarding interventions applied and study results.
When looking at the effect of aerobic exercise versus control group or other intervention groups measured with VAS, it can be observed, that there was a great heterogeneity between studies results (different magnitudes and directions). Although none of the comparisons showed a statistically significant difference between aerobic exercise and control (MD 6.24 mm, 95% CI [-11.21; 23.96]) or active intervention groups (MD -9.52 mm, 95% CI [-18.48; -0.56]) on pain intensity; it seems that aerobic exercise is slightly better than a control group, and equally effective as other active treatments such as strength exercise or education.
In addition, when combined with other therapeutic modalities, aerobic exercise, could potentially help to reduce pain intensity (MD 7.71 mm, 95% CI [1.07; 14.35]). Especially in the long term, the combination of strength and aerobic exercise showed promising results. Statistically significant differences in favour of aerobic exercise for pre vs. three months follow up (MD 11.20 mm, 95% CI [2.85;19.55]) and pre vs. six moths follow up (MD 15.10 mm, 95% CI [6.99; 23.21]) were found.
Conclusions:
Although there is currently limited evidence on the effectiveness of aerobic exercise in individuals with chronic neck pain, aerobic exercise was found to not only reduce pain intensity, but also to improve disability as well as physical and emotional functioning. However, as the evidence is limited, low quality, and heterogeneous, further research is needed in this area to obtain more accurate results.
Hintergrund: Instrumentalisten leiden häufig unter spielbedingten (neuro-) muskuloskelettalen Erkrankungen. Diese zeigen sich bei Streichern, wie Violinisten, Bratschisten und Cellisten, am häufigsten in Form von Beschwerden im Oberkörper – insbesondere im Schulter-Nacken-Bereich. Die apparative Bewegungsanalyse hat sich bereits als hilfreich bei der Beurteilung von muskuloskelettalen Erkrankungen und schädlichen Bewegungsmustern erwiesen und wird für die Diagnostik bei funktionellen Störungen empfohlen. Es wurde bereits gezeigt, dass die apparative biomechanische Bewegungsanalyse ein valides und klinisch praktikables Werkzeug für die genaue und objektive Untersuchung von Bewegungen bei Streichern ist, jedoch ist ihr Einsatz in der klinischen Konsultation immer noch sehr unüblich. Aus diesem Grund existiert ein Mangel an gut etablierten Bewegungsanalyse-Protokollen zur Untersuchung funktioneller Störungen bei Streichern unter Einsatz biomechanischer Instrumente in einem klinischen Umfeld wie der Physiotherapie.
Ziel ist es daher, die Entwicklung und Anwendung eines solchen Protokolls vorzustellen für die Beurteilung der funktionellen Spielbewegungen des Oberkörpers bei sowohl hohen als auch tiefen Streichern in einem physiotherapeutischen Umfeld.
Methode: Zunächst wurden auf Basis einer klinischen Fragestellung relevante Symptombereiche und Messparameter bestimmt. Anschließend wurden beteiligte Segmente, Gelenke und Muskeln selektiert. Darauf basierend wurde ein umfassendes (mechanisches) Modell des Oberkörpers sowie die dazugehörigen Koordinatensysteme und Rotationssequenzen definiert. Dies lenkte sowohl die Spezifikation eines speziell angefertigten Marker-Sets sowie fortgeschrittener Ansätze wie zur funktionellen Bestimmung von Gelenkzentren und -achsen, als auch die Auswahl und Platzierung von Oberflächenelektroden. Schließlich wurden Aktivitäten zur Kalibrierung und Untersuchung der Bewegungsfunktion sowie relevante Analyseparameter und deren Darstellungsformen festgelegt.
Die Protokolldurchführung beinhaltet zunächst die Auswahl der zu untersuchenden Segmente, Gelenke und Muskeln ausgehend von einer oder mehreren klinischen (Arbeits-)Hypothesen bzw. von den spezifischen Symptombereichen. Darauf basierend werden die benötigten Marker und Oberflächenelektroden konfiguriert und platziert. Anschließend werden die festgelegten Kalibrierungsmessungen und Bewegungsaufgaben durchgeführt. Schließlich werden die relevanten Ergebnisparameter zur Überprüfung der Hypothesen extrahiert.
Der klinische Einsatz der Methode wird exemplarisch anhand einer Violinistin mit spielbedingten Schmerzen erläutert.
Klinische Implikationen: Die potenzielle Anwendung des vorgestellten Vorgehens ist die intra-individuelle Evaluation von gleichzeitig der Gelenk- als auch der Muskelfunktion bei hohen und tiefen Streichern während der physiotherapeutischen Konsultation. Dies soll sowohl zur Diagnose funktioneller Erkrankungen des Bewegungsapparates in Form einer objektiven, umfassenden und dennoch klinisch praktikablen diagnostischen Untersuchung als auch zum prä-post-interventionellen Vergleich beitragen.
background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related MP. To provide a specific physiotherapeutic management for performing artists it is important to gain information about the performing art, the individual demands and contributing factors. The subjective examination (SE) is the basis of the clinical reasoning process and the hypothesis forming for further clinical examination and biomechanical analysis. In the present protocol, the SE consists of a questionnaire-based section and an interview-based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: To develop a standardized SE protocol divided into a questionnaire-based section (Part 1) via web application and an interview-based SE (Part 2) to address MP of performing artists.
methods: The questionnaires for part 1 were selected based on the expertise of the research group and the psychometric properties of each possible questionnaire. A common physiotherapeutic recording of findings which addresses the relevant questions of the SE of MP was used. To adapt the anamnesis to performing-associated MP questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
summary of content/results: Part 1 consists of three topics. (1) information about the performing art, professional level and sociodemographic data, (2) information about pain and pain processing, and (3) the anatomical location of the main MP including a body region-specific questionnaire. Part 2 is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. The performing arts specific part is particularly focused on performing art specific considerations, physical and psychosocial contributing factors and art-specific activities.
significance: This standardized SE protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
Background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. In order to specifically evaluate these problems, a reference laboratory is under development. The evaluation covers 4 steps: a subjective examination (SE) including (1) a questionnaire-based online survey and (2) an interview-based anamnesis. On the basis of the results of the SE, hypotheses are formed for (3) an individual musculoskeletal clinical examination and a (4) biomechanical analysis. Here, the focus is on the clinical examination.
Purpose: to develop a standardized protocol for a clinical examination addressing especially musculoskeletal problems in performing artists.
Methods: A common physiotherapeutic clinical examination should be supplemented with techniques, which are specific to performance-related musculoskeletal problems and/or their risk factors. The development was based on a literature search and the clinical expertise of the physiotherapeutic research group.
Summary of content/Results: The performing arts specific clinical examination includes the common analysis of posture as well as passive/active movement capacities and specific differentiating tests in relation to the signs and symptoms of the individual artist. The examination is supplemented by a functional demonstration focusing on the special demands of playing the respective instrument, while singing or dancing. Common overuse risk factors like hypermobility, special anthropometric data or an examination of the motor control of different body regions are addressed. Optional, the various parts of the examination process could be skipped, if not relevant for the individual artist.
Significance: This clinical examination protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
Die deutschen Kommunen stehen aktuell vor schweren Herausforderungen: der durch die Covid-19-Pandemie bedingte wirtschaftliche Abschwung hat zu massiven Einbrüchen in den kommunalen Steuereinnahmen geführt und gleichzeitig hohe außerplanmäßige Ausgaben bewirkt. Weitere zeitaktuelle Herausforderungen für den kommunalen Finanzhaushalt sind die drohende Energiekrise und die hohe Inflation. Daraus resultierend befinden sich die Kommunen in einer angespannten Haushaltslage und sind gezwungen, unpopuläre Sparmaßnahmen zwecks Haushaltsausgleich einzuleiten. Auch der Landkreis Osnabrück unterliegt einem enormen Konsolidierungsdruck. Die Verwaltungsführung und die politischen Gremien haben beschlossen, ein umfassendes Haushaltskonsolidierungskonzept durchführen zu lassen, im Rahmen dessen u. a. Aufgabenkritik ausgeübt werden soll. Hierbei unterliegen insb. freiwillige Aufgaben einer strengen Aufgabenkritik. Zu den freiwilligen Aufgaben gehört auch die Europaarbeit des ED. Das ED ist eine zentrale europäische Anlaufstelle für die Bevölkerung der Region Osnabrück, bei der sich die Bürger über die EU informieren und zu allerlei europabezogenen Anliegen beraten lassen können. Vor dem Hintergrund der geschilderten Situation steht der ED-Leiter nun vor der Herausforderung, die Europaarbeit des ED vor der Politik und Verwaltungsführung zu rechtfertigen. Aus diesem Anlass untersucht die Verfasserin in der vorliegenden Arbeit, welche Bedeutung dem ED des Landkreises Osnabrück aus Bürgersicht zukommt. Hierzu nimmt sie eine Betrachtung des ED aus aufgabenkritischer Perspektive vor. Im Rahmen der Betrachtung zieht sie die ihr zugrundeliegenden Informationen über das ED sowie Ergebnisse einer stichprobenartigen Umfrage heran.
Im Ergebnis stellt sich heraus, dass die ED-Europaarbeit beibehalten und weiterhin durch den Landkreis Osnabrück wahrgenommen werden sollte. Im Hinblick auf den Geschäftsprozess ergibt sich die Notwendigkeit zu einer Reduktion des Aufgabenumfangs und einer Umpriorisierung der Aufgaben. Insofern bestehen Optimierungspotentiale, die im Rahmen einer GPO näher analysiert werden müssten.
The increasing diversity of cultural backgrounds offers potential for a more elaborated information processing, yet has been shown to be challenging for individuals, due to intergroup hostility, prejudices, and difficulties of intercultural communication. Current research thus focusses on the interaction of employees with different cultural heritages, as well as on their intergroup attitudes and competences. Thereby, leaders have been shown to shape the way diversity is considered in their teams in a top-down process. However, their perception of diversity as well as related challenges and chances are poorly investigated. The current paper thus aims to contribute to the understanding of leader’s perspective on and role in diversity-management by building on a comparative qualitative study with sixteen employees and twenty-two leaders. Research questions are how employees and leaders perceive cultural diversity from their specific point of view, which experiences are likely to contribute to their opinion on and perception of diversity and in how far do employees and leaders differ in these aspects. The results show that employees are aware of the topic of diversity in general but have poor competences in dealing with diversity in their daily working life. This seems to be associated with lack of experience with intercultural interaction and a lack of support from the respective organizations/leaders. Leaders are rarely aware of this lack of support. The results indicate that leaders’ experiences with cultural and age diversity, their identification with the company and previous diversity measures in the context of the companies’ policy towards diversity seem to be relevant for the formation of leaders’ attitudes. As a consequence, most participants focus on the question whether they do or do not want diversity within their teams and companies, while they actually fail to perceive the diversity that is already there.
The Corona pandemic confronted societies with several unexpected constraints that had the effect of making certain goods much scarcer than before. Withdrawal from Russian oil and gas supplies has a similar effect. Carbon abatement can also be seen as a deliberate choice to make certain goods scarc-er than they actually are. These parallels suggests that it may be worthwhile to take a close look at societies’ responses to all three challenges. This paper makes an attempt to synthetize empirical and theoretical insights regarding these scarcity shocks from a well-being perspective, i.e. replacing the prevalent welfare economic focus on production and consumption with a focus on sustainable well-being.
Taking the case of Germany, it will be argued that the observed responses to all three challenges reflect a focus on maintaining incomes and production and that therefore these responses risk being detrimental to sustainable wellbeing and even to economic stability. This is particularly relevant if carbon abatement requires not only transient material sacrifices but lasting and significant reduc-tions of consumption.
It will be argued that the impact of these new scarcities will be much less problematic in a society that acknowledges the priority of sustainable wellbeing over production and consumption measures. Such a society would still need to incur material sacrifices, but these need not translate into a loss of wellbeing if economic conditions and social norms adapt. This will also be more sustainable not only in terms of ecological impact, but also in terms of debt, inflation and inequality.
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1.understand and describe the basic principles of EMG
2.understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3.use EMG on performing artists in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1.Short presentation: introduction and understanding of EMG (educational objective 1)
2.Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3.Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Introduction: Hamstring injuries are among the most common injuries in soccer players. Especially the danger of hamstring injuries increases in the final third of each half, with the biceps femoris muscle being highly susceptible, but currently there is no supporting evidence in soccer players. It is important to investigate to provide a basis for further clinical investigations in order to reduce the risk of hamstring injuries.
Objective: To investigate a soccer-specific muscle fatigue protocol has an effect on the activation patterns of the biceps and semitendinosus muscles and correlates with the subjectively perceived exertion of the soccer players.
Methods: 19 healthy soccer players aged 19 - 35 years were included and underwent a standardized procedure that included: (1) performance of the nordic hamstring curls (NHC) and a 10m sprint (pre-test), (2) a soccer-specific muscle fatigue loading protocol for 30 minutes with subsequent rating of perceived exertion (RPE), (3) re-assessed like pre-assessment (post- test). Electromyography (EMG) data were recorded the biceps and
semitendinosus muscles of both legs. Two parameters were analyzed: the peak amplitude during the NHC and the mean amplitude during the 10m sprint.
Results: The RPE score (9.5, p<0.001) and 10m sprint shows significant differences between pre- and post- test for the biceps (standing leg: -82.45, kicking leg: -81.77; p<0.01) and semitendinosus muscle (standing leg: -60.08, p=0.001); kicking leg: -65.30, p=0.03). Significant correlation exists between RPE score and biceps muscles at posttest (standing leg: r=-0.54, kicking leg: r=-0.51; p<0.05).
Conclusion: Muscle fatigue leads to significant changes in the activation behavior of the hamstring muscles. In particular, the biceps muscle shows a correlation with perceived exertion, the higher the exertion, the lower the muscle activity. This may help explain the higher prevalence of the biceps muscle in hamstring injuries and offers a basis for further clinical investigations
Rationale
Playing the trombone can lead to playing-related musculoskeletal disorders (PRMD). Previous research suggests that professional trombonists predominantly struggle with PRMD on the left body side. An increasing volume leads to an increasing contact pressure on the mouthpiece of the trombone, but it is still unclear how the muscle activity relates to this and whether it differs in musicians with PRMD from those without PRMD.
Purpose
The purpose of this study was to investigate the relationship between the activity of different muscles of the left body side, the contact pressure on the mouthpiece and the volume level in healthy trombonists.
Methods
Six male healthy tenor trombonists were included in this study and run through a standardized protocol which consisted of playing a b-flat major scale with three different volume levels (pianissimo, mezzoforte, fortissimo). Analyzed parameters were (1) the activity of several muscles of the left body side (measured with surface electromyography), (2) the contact pressure on the mouthpiece (measured with a force sensor) and (3) the different volume levels.
Results
Analysis of variance reveals significant differences of the muscle activity for the three volume levels. Depending on the volume level and the selected muscle, results show very weak to moderate correlations between contact pressure on the mouthpiece and muscle activity (Spearman´s rho between .11 and .58). The strongest correlation across all muscles occurs during fortissimo playing.
Conclusions
These results show a relationship in healthy trombonists between volume level, contact pressure on the mouthpiece and muscle activity when playing a b-flat major scale. Future research should include trombonists with PRMD to enable comparison between PRMD and non-PRMD musicians.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. understand the relationship between muscle activity, contact pressure on the mouthpiece and volume when playing the trombone
2. recognize that there are different muscle activity patterns on the left body side when playing the trombone
3. understand that a comprehensive functional diagnosis is important in the management of musicians
The diabetic foot ulcer, which 2% – 6% of diabetes patients experience, is a severe health threat. It is closely linked to the risk of lower extremity amputation (LEA). When a DFU is present, the chief imperative is to initiate tertiary preventive actions to avoid amputation. In this light, clinical decision support systems (CDSS) can guide clinicians to identify DFU patients early. In this study, the PEDIS classification and a Bayesian logistic regression model are utilised to develop and evaluate a decision method for patient stratification. Therefore, we conducted a Bayesian cutpoint analysis. The CDSS revealed an optimal cutpoint for the amputation risk of 0.28. Sensitivity and specificity were 0.83 and 0.66. These results show that although the specificity is low, the decision method includes most actual patients at risk, which is a desirable feature in monitoring patients at risk for major amputation. This study shows that the PEDIS classification promises to provide a valid basis for a DFU risk stratification in CDSS.
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.
Diabetic foot ulcer (DFU) is a chronic wound and a common diabetic complication as 2% – 6% of diabetic patients witness the onset thereof. The DFU can lead to severe health threats such as infection and lower leg amputations, Coordination of interdisciplinary wound care requires well-written but time-consuming wound documentation. Artificial intelligence (AI) systems lend themselves to be tested to extract information from wound images, e.g. maceration, to fill the wound documentation. A convolutional neural network was therefore trained on 326 augmented DFU images to distinguish macerated from unmacerated wounds. The system was validated on 108 unaugmented images. The classification system achieved a recall of 0.69 and a precision of 0.67. The overall accuracy was 0.69. The results show that AI systems can classify DFU images for macerations and that those systems could support clinicians with data entry. However, the validation statistics should be further improved for use in real clinical settings. In summary, this paper can contribute to the development of methods to automatic wound documentation.
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.
Venous leg ulcers and diabetic foot ulcers are the most common chronic wounds. Their prevalence has been increasing significantly over the last years, consuming scarce care resources. This study aimed to explore the performance of detection and classification algorithms for these types of wounds in images. To this end, algorithms of the YoloV5 family of pre-trained models were applied to 885 images containing at least one of the two wound types. The YoloV5m6 model provided the highest precision (0.942) and a high recall value (0.837). Its mAP_0.5:0.95 was 0.642. While the latter value is comparable to the ones reported in the literature, precision and recall were considerably higher. In conclusion, our results on good wound detection and classification may reveal a path towards (semi-) automated entry of wound information in patient records. To strengthen the trust of clinicians, we are currently incorporating a dashboard where clinicians can check the validity of the predictions against their expertise.
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.
This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.
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.
In the context of the ongoing digitization of interdisciplinary subjects, the need for digital literacy is increasing in all areas of everyday life. Furthermore, communication between science and society is facing new challenges, not least since the COVID-19 pandemic. In order to deal with these challenges and to provide target-oriented online teaching, new educational concepts for the transfer of knowledge to society are necessary. In the transfer project “Zukunftslabor Gesundheit” (ZLG), a didactic concept for the creation of E-Learning classes was developed. A key factor for the didactic concept is addressing heterogeneous target groups to reach the broadest possible spectrum of participants. The concept has already been used for the creation of the first ZLG E-Learning courses. This article outlines the central elements of the developed didactic concept and addresses the creation of the ZLG courses. The courses created so far appeal to different target groups and convey diverse types of knowledge at different levels of difficulty.
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.
Rationale:
Neck pain is a large health problem worldwide and often seen in musicians [1, 2]. Neck pain can radiate into the arm due to various underlying pain types and pain mechanisms making it heterogeneous in clinical signs and symptoms [3-5]. On the one hand, patients may present with dominant nociceptive neck-arm pain caused by activation of the nociceptors in muscles, joints, ligaments, fascia, tendons and the connective tissues of a nerve [6, 7]. Activation of nociceptors in nerve connective tissues may cause clinical signs of heightened nerve mechanosensitivity what is per definition categorized as nociceptive pain [6, 8, 9]. On the other hand, patients may present with dominant neuropathic pain, defined as pain as a direct consequence of a lesion or disease affecting the somatosensory system [10, 11]. The clinical profile of these different pain types is sometimes difficult to disentangle based on the localization and pain character [12]. Moreover, non-specific neck-arm pain patients shown a neuropathic pain component based on somatosensory changes detected via Quantitative Sensory Testing (QST) [3, 13]. Classifications with a defined physical examination pathway can be helpful to define subgroups to guide the clinical decision making [14]. This workshop updates the background about the pathophysiology of neck-arm pain and mediates an evidence-based examination to classify patients.
Purpose:
The aim of this workshop is to give a current insight into the background and evidence of neck-arm pain and to plan and practice a physical examination.
Content of Presentation:
This workshop will summarize evidence of neck-arm pain. Thereupon, current evidencebased diagnostic options will be presented and practiced together. Finally, a short insight in the management of neck-arm pain will be given.
Approach of Presentation:
QST testing and current cost-effective evidence-based methods will be presented to identify neuropathic components in neck-arm pain. Selected methods will be performed practically together, e.g. bedside sensory testing and neurodynamic tests.
Clinical Significance:
After the workshop, participants will have improved skills to diagnose in the spectrum of neck-arm pain for musicians with neck-arm pain.
At the end of the presentation, the participants will be able to:
- understand the heterogeneity of neck-arm pain,
- plan an appropriate diagnostic physical examination,
- have an insight in possible management strategies.
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.
Hintergrund
Schmerz hat einen entscheidenden Einfluss auf die humane Lebensqualität. Allein eine Wissensvergrößerung über neurobiologische Vorgänge kann das subjektive Schmerzempfinden sowie psychometrische Variablen positiv beeinflussen. Es gibt verschiedene Formen der präoperativen Patientenedukation, welche u. a. zum Ziel haben, den postoperativen Schmerz zu erklären. Laut der aktuellen Literatur liegt einer präoperativen biomedizinischen Edukation eine geringe Evidenz zugrunde. Sie kann das präoperative Angst- und Stresslevel der Patienten steigern, was sich negativ auf das postoperative Outcome auswirkt. Im Gegensatz zur biomedizinischen Edukation betrachtet das neurobiologische Verständnis den postoperativen Schmerz unter den Gesichtspunkten der Plastizität des Nervensystems und bezieht Sensibilisierungsprozesse im zentralen und peripheren Nervensystem mit ein.
Ziel
Systematische Untersuchung von Kurz- und Langzeiteffekten einer neurobiologischen (Schmerz‑)Edukation bei Patienten vor einer Wirbelsäulenoperation
Material und Methoden
Bei der Literaturrecherche wurde nach dem PI(C)O(Population Intervention Comparison Outcome)‑Schema in den medizinischen Datenbanken gesucht. 83 Artikel kamen in die engere Auswahl. Entsprechend den Ein- und Ausschlusskriterien konnten letztendlich neun Artikel eingeschlossen werden.
Ergebnisse
Durch eine präoperative neurobiologische (Schmerz‑)Edukation können postoperative Katastrophisierungstendenzen sowie die postoperative Kinesiophobie positiv beeinflusst werden. Keinen Einfluss hat eine präoperative neurobiologische Edukation auf postoperativen Schmerz und Funktion. Inkonsistenz besteht bislang in der Herangehensweise der PNE (Pain Neuroscience Education).
Schlussfolgerung
Eine präoperative Reduktion von Angst und schmerzaufrechterhaltenden Faktoren v. a. auf psychologischer und sozialer Ebene hat einen positiven Effekt auf die postoperative subjektive Schmerzbewertung, was sich in einer Reduktion von Angst, Katastrophisierungstendenzen und einer geringeren Inanspruchnahme von postoperativen Leistungen im Gesundheitswesen widerspiegelt.