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Co-financing arrangements in which investors from outside the motion picture industry become co-owners of the completed films are a common phenomenon in Hollywood. Kay H. Hofmann analyzes the conflicts of interest and the organizational problems that may arise between the experienced major studios and investors with comparably low industry expertise. Guided by principal agent theory, the empirical analysis provides evidence for adverse selection and moral hazard. Based on his findings, the author develops solutions that are not only relevant for investors but also for film producers who rely on the long-term availability of external funds.
Background: Clinical handovers at changes of shifts are typical scenarios of time restricted and information intensive communication, which are highly cognitively demanding. The currently available applications supporting handovers typically present complex information in a textual checklist-like manner. This presentation style has been criticised for not meeting the specific user requirements.
Objectives: We, therefore, aimed at developing a concept for visualising the overview of a clinical case that serves as an alternative way to checklist-like presentations in clinical handovers. We also aimed at implementing this concept in a handoverEHR in order to support the pre-handover phase, the actual handover, and the post-handover phase as well as at evaluating its usability and attractiveness.
Results: We developed and implemented a concept that draws on Tolman's pioneering work on cognitive maps that we designed in accordance with Gestalt principles. These maps provide a pictorial overview of a clinical case. The application to build, manipulate, and store the cognitive maps was integrated into an openEHR based handover record that extends conventional records with handover specific information. Usability (n = 28) and attractiveness (n = 26) testing with experienced clinicians resulted in good ratings for suitability for the task as well as for attractiveness and pragmatism.
Conclusion: We propose cognitive maps to represent and visualise the clinical case in situations where there is limited time to present complex information.
Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups.
Background: Multilingual children with suspected SLCN are often overlooked or their needs not accurately differentiated regarding the necessity of language support or therapy. The purpose of the study was to conceptualize, carry out and evaluate a local language support (LS) project within linguistically and culturally diverse (LCD) families and its effects on all collaborating participants.
Methods: Eight SLT students and one lecturer took part in the LS-project, alongside equivalent numbers of family liaison personnel. Students visited more than 10 young children aged between 2-6 years, and for each child 10 weekly home visits were carried out. Language enhancement was documented, several case studies with children and interviews with five liaison personnel conducted.
Results: All SLT students perceived changes in the behaviour and communication of participating children. Children in the case studies developed from pre-verbal to verbal means of communication and family liaison personnel reported positive changes alongside parental wishes to continue the support.
Conclusion: Local language support projects with LCD families can lead to positive differences regarding their children's communication development and better inclusion in mainstream society. SLT students benefit from working with LCD families and their collaborative support together with family liaison personnel, and vice versa.
Learning Outcomes: To differentiate the influence of language enhancement vs. formalized SLT therapy. To enhance the relationship with LCD clientele and collaboration with liaison personnel in SLCN settings. To incorporate life-long learning and intercultural sensitization.
Comparison of quantitative sensory testing profles between people living in Germany and Australia
(2021)
While Nursing Informatics competencies seem essential for the daily work of nurses, they are not formally integrated into nursing education in Austria, Germany and Switzerland, nor are there any national educational recommendations. The aim of this paper is to show how such recommendations can be developed, what competency areas are most relevant in the three countries and how the recommendations can be implemented in practice. To this end, a triple iterative procedure was proposed and applied starting with national health informatics recommendations for other professionals, matching and enriching these findings with topics from the international literature and finally validating them in an expert survey with 87 experts and in focus group sessions. Out of the 24 compiled competency areas, the relevance ratings of the following four recommended areas achieved values above 90%: nursing documentation (including terminologies), principles of nursing informatics, data protection and security, and quality assurance and quality management. As there were no significant differences between the three countries, these findings laid the foundation of the DACH Recommendations of Nursing Informatics as joint German (D), Austrian (A), and Swiss (CH) recommendations in Nursing Informatics. The methodology proposed has been utilized internationally, which demonstrates the added value of this study also outside the confines of Austria, Germany, Switzerland.
Current challenges are a result of complex and multi-layered factors. They require systemic solutions: problems must be solved holistically by identifying interconnections between the different problems which are results of the same root cause. Social entrepreneurs are agents of change, their mission is to generate societal impact. I investigated how a social entrepreneurship think tank can be conceptualized to support systems change. Think tanks can conduct in-depth research to inform about the systems and share knowledge. Entrepreneurs can make strategic interventions based on the research findings. To create a framework of how social entrepreneurship think tanks can promote systems change I conducted 14 case studies. The framework is created based on the method of Theory of Change, it displays how different activities can contribute to succeeding in systems change. I outline eleven activities which include strategies in capacity building, research and collaboration with the other actors in the field. In the end, the framework is applied to the evolving case of a think tank founded in 2018.
Conceptualising event value co-destruction and developing a future agenda for events research
(2021)
Purpose
Value co-destruction has received little attention in an event-related context. This appears surprising, given that the interactions among actors at an event may also reduce the value for other participants, stakeholders and that of the entire event or the event's service ecosystem. This paper first aims to conceptualise value co-destruction and to provide an overview of related research in an event context. Second, a future research agenda for value co-destruction processes in an event context is developed.
Design/methodology/approach
Journals of the “Scimago Journal and Country Rank” were systematically reviewed for the keywords “value co-destruction”, “value destruction” and “negative value co-creation”. A second literature review specifically aimed at the events context extended the search scope to non-Scimago journals, Google Scholar and Google Web using the same keywords. All identified articles were qualitatively analysed concerning (1) the conceptualisation of value co-destruction and (2) reasons for value co-destruction.
Findings
The review of previous research highlights a limited scope of analysis, a focus on value co-destruction as an outcome and on interactions at the meso-level. Based on these findings, a holistic definition of value co-destruction is proposed. The paper identifies two major directions for future studies on value co-destruction at events and suggests specific examples.
Originality/value
The paper contributes to a more holistic understanding of value co-creation and co-destruction in an event setting. For example, a clearer understanding of the interactions that reduce the overall value of an event may assist to better design valuable events in the future.
Background:
The evaluation of somatosensory dysfunction is important for diagnostics and may also have implications for prognosis and management. The current standard to evaluate somatosensory dysfunction is quantitative sensory testing (QST), which is expensive and time consuming. This study describes a low-cost and time-efficient clinical sensory test battery (CST), and evaluates its concurrent validity compared to QST.
Method: Three patient cohorts with carpal tunnel syndrome (CTS, n=86), 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 mechanical and thermal detection and pain thresholds and testing both loss and gain of function. Agreement rate, significance and strength of correlation between CST and QST were calculated.
Results: Several CST parameters (cold and warm detection, cold pain, mechanical detection, mechanical pain for loss of function, pressure pain) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and weak to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger correlation in the CTS and NSNAP cohort, whereas loss of function parameters performed better in the LR cohort. Other CST parameters (vibration detection, heat pain, mechanical pain for gain of function, windup ratio) did not significantly correlate with QST.
Conclusion: Some, but not all tests in the CST battery can detect somatosensory dysfunction as determined with QST. The CST battery may perform better when the somatosensory phenotype is more pronounced.
Abstract: Thermal response curves that depict the probability of occurrence along a thermal gradient are used to derive various species’ thermal properties and abilities to cope with warming. However, different thermal responses can be expected for different portions of a species range. We focus on differences in thermal response curves (TRCs) and thermal niche requirements for four freshwater fishes (Coregonus sardinella, Pungitius pungitius, Rutilus rutilus, Salvelinus alpinus) native to Europe at (1) the global and (2) European continental scale. European ranges captured only a portion of the global thermal range with major differences in the minimum (Tmin), maximum (Tmax) and average temperature (Tav) of the respective distributions. Further investigations of the model-derived preferred temperature (Tpref), warming tolerance (WT = Tmax − Tpref), safety margin (SM = Tpref − Tav) and the future climatic impact showed substantially differing results. All considered thermal properties either were under- or overestimated at the European level. Our results highlight that, although continental analyses have an impressive spatial extent, they might deliver misleading estimates of species thermal niches and future climate change impacts, if they do not cover the full species ranges. Studies and management actions should therefore favor whole global range distribution data for analyzing species responses to environmental gradients.
Thermal response curves that depict the probability of occurrence along a thermal gradient are used to derive various species’ thermal properties and abilities to cope with warming. However, different thermal responses can be expected for different portions of a species range. We focus on differences in thermal response curves (TRCs) and thermal niche requirements for four freshwater fishes (Coregonus sardinella, Pungitius pungitius, Rutilus rutilus, Salvelinus alpinus) native to Europe at (1) the global and (2) European continental scale. European ranges captured only a portion of the global thermal range with major differences in the minimum (Tmin), maximum (Tmax) and average temperature (Tav) of the respective distributions. Further investigations of the model-derived preferred temperature (Tpref), warming tolerance (WT = Tmax − Tpref), safety margin (SM = Tpref − Tav) and the future climatic impact showed substantially differing results. All considered thermal properties either were under- or overestimated at the European level. Our results highlight that, although continental analyses have an impressive spatial extent, they might deliver misleading estimates of species thermal niches and future climate change impacts, if they do not cover the full species ranges. Studies and management actions should therefore favor whole global range distribution data for analyzing species responses to environmental gradients.
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.
Data warehouse systems have become a basic technological infrastructure in management decision making. Nevertheless, the overall utility of data warehouses remains unmeasured in most practical cases. As a consequence of this, IT-managers do not possess appropriate means to evaluate warehouse benefits in order to decide about investments in warehousing technology. This paper develops a controlling instrument for data warehouse systems based on the Balanced Scorecard (BSC) approach. On the basis of the technological aspects of data warehouse systems, the BSC perspectives are developed and populated with relevant objectives and measures for datawarehouse success. These perspectives are integrated into a consistent data warehouse scorecard. Finally, this instrument provides a holistic approach to drive the performance of data warehouse systems.
The well-documented social gradient in health in the developed world will not just disappear on its own. Tackling health inequalities by introducing a universal coverage healthcare system recently became an important notion in the U.S. Using cross-sectional data from Germany which has maintained its compulsory egalitarian healthcare system for more than 50 years now, we apply logistic and negative binomial regression to uncover utilisation behaviour patterns under universal coverage. We find that lower education and unemployment raise the risks for all diseases under consideration. Unemployment increases the chance of contacting a physician, while income and education do not apparently affect the healthcare utilisation behaviour. Those diseases concentrated among unemployed and less educated, however, are associated with intensified healthcare utilisation. We conclude that universal coverage may make access to health care easier for those facing the worst health; the unemployed and lower educated.
In this paper we want to review and discuss research on the effects of occupational health management activities and services on different outcomes like employee health and well-being or absenteeism and other economic outcomes. In part I we outline goals and functions of occupational health management (OHM), then characterize typical occupational health promotion interventions and describe principles for implementing and organizing OHM. Part II focuses on different OHM activities and services such as creating healthy and safe workplace, reducing work-family conflicts, providing counselling via employee assistance programs and implementing health circles or stress management interventions. We will also discuss intervention design and sample studies as well as meta-analytic data relating to the effectiveness of these interventions. Finally, part III is about the economic impact of OHM. Findings from a management evaluation approach for OHM will be discussed. Then we will concentrate especially on data linking health promotion interventions to absenteeism and financial outcomes expressed as cost savings or cost-benefit ratios. The concluding part summarizes key findings of this paper.
The conservation of freshwater ecosystems has lagged behind that of marine and terrestrial ecosystems and often requires the integration of large-scale approaches and transboundary considerations. This study aims to set the foundations of a spatial conservation strategy by identifying the most important catchments for the conservation of freshwater biodiversity in Europe.
Using data on 1296 species of fish, mollusc, odonate and aquatic plant, and the key biodiversity area criteria (species Red List status, range restriction and uniqueness of species assemblages), we identified a network of Critical Catchments for the conservation of freshwater biodiversity. Applying spatial prioritisation, we show how the prioritised network differs from the ideal case of protecting all Critical Catchments and how it changes when protected areas are included, and we also identify gaps between the prioritised network and existing protected areas.
Critical Catchments (n = 8423) covered 45% of the area of Europe, with 766 qualifying (‘trigger’) species located primarily in southern Europe. The prioritised network, limited to 17% of the area of Europe, comprised 3492 catchments mostly in southern and eastern Europe and species targets were met for at least 96% of the trigger species.
We found the majority of Critical Catchments to be inadequately covered by protected areas. However, our prioritised network presents a possible solution to augment protected areas to meet policy targets while also achieving good species coverage.
Policy implications. While Critical Catchments cover almost half of Europe, priority catchments are mostly in southern and eastern Europe where the current level of protection is not sufficient. This study presents a foundation for a Europe-wide systematic conservation plan to ensure the persistence of freshwater biodiversity. Our study provides a powerful new tool for optimising investment on the conservation of freshwater biodiversity and for meeting targets set forth in international biodiversity policies, conventions and strategies.
HRM processes are increasingly AI-driven, and HRM supports the general digital transformation of companies’ viable competitiveness. This paper points out possible positive and negative effects on HRM, workplaces, and workersorganizations along the HR processes and its potential for competitive advantage in regard to managerial decisions on AI implementation regarding augmentation and automation of work.
A systematic literature review that includes 62 international journals across different disciplines and contains top-tier academic and German practitioner journals was conducted. The literature analysis applies the resource-based view (RBV) as a lens through which to explore AI-driven HRM as a potential source of organizational capabilities.
The analysis shows four ambiguities for AI-driven HRM that might support sustainable company development or might prevent AI application: job design, transparency, performance and data ambiguity. A limited scholarly discussion with very few empirical studies can be stated. To date, research has mainly focused on HRM in general, recruiting, and HR analytics in particular.
The four ambiguities’ context-specific potential for capability building in firms is indicated, and research avenues are developed.
This paper critically explores AI-driven HRM and structures context-specific potential for capability building along four ambiguities that must be addressed by HRM to strategically contribute to an organization’s competitive advantage.
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.
Every culture has its paradise vision: desirable and external conditions which, inside the concerned culture, are infrequently observed or difficult to realize and are linked to one another. This cross-cultural study compares well-being inChina,Bulgaria,FranceandGermany. The cultural patterns of the culture are differently, but well-being is easier to achieve if people adapt to their cultural patterns. The adjustment (positive subjective culture) is formed by culture-specific content and needs different in regards to different cultures.
Objectives: The aims of this study were to define the Faces Pain Scale-Revised (FPS-R) and Color Analog Scale (CAS) scores associated with no pain, mild pain, moderate pain, and severe pain in children with acute pain, and to identify differences based on age, sex, and ethnicity.
Methods: We conducted a prospective observational study in 2 pediatric emergency departments of children aged 4 to 17 years with painful and nonpainful conditions. We assessed their pain intensity using the FPS-R, CAS, and qualitative measures. Pain score cut points that best differentiated adjacent categories of pain were identified using a receiver operating characteristic-based method. Cut points were compared within subgroups based on age, sex, and ethnicity.
Results: We enrolled 620 patients, of whom 314 had painful conditions. The mean age was 9.2 years; 315 (50.8%) were in the younger age group (aged 4-7 years); 291 (46.8%) were female; and 341 (55%) were Hispanic. The scores best representing categories of pain for the FPS-R were as follows: no pain, 0 and 2; mild pain, 4; moderate pain, 6; and severe pain, 8 and 10. For the CAS, these were 0 to 1, 1.25 to 2.75, 3 to 5.75, and 6 to 10, respectively. Children with no pain frequently reported nonzero pain scores. There was considerable overlap of scores associated with mild and moderate pain. There were no clinically meaningful differences of scores representing each category of pain based on age, ethnicity, and race.
Conclusions: We defined pain scores for the FPS-R and CAS associated with categories of pain intensity in children with acute pain that are generalizable across subgroups based on patient characteristics. There were minor but potentially important differences in pain scores used to delineate categories of pain intensity compared to prior convention.
The demographic shift in the age structure has the effects that many ageing employees work in organisations. Migration can slow down the ageing of population but could not stop it. More and more people with immigration background work in organisations. Therefore, the question is, whether diversity sensitive attitudes count for all diversity aspects. The central aim of the study is to deal with the problem fields of multicultural teamwork. Thereby, the focus is on the collaboration of employees with and without immigration background. The interviews with employees with and without an immigra-tion background of various company branches were conducted. The results show that employees with an immigration background have more contact and feel comfortable with persons from different cultures than employees without an immigration back-ground. The qualitative analysis indicates that there is a high need of competence devel-opment, especially intercultural and social competences in organisations. The results of the study reveal that personality traits and characteristics of employees play a role to what extent they accept diversity and are willing to work with persons from another culture. Age is not important regarding intercultural competence development.
Suicide is a major cause of death in adulthood and specifically in patients suffering from mental illnesses. The Depressive Symptom Inventory Suicidality Subscale (DSI-SS) is widely used to detect and prevent suicidal ideation. The aim of the present study was to determine optimal cut points for the DSI-SS in different populations.
We analysed the data of one population-based sample (n = 532), one outpatient sample (n = 180) and one inpatient sample (n = 244). Internal consistency, convergent validity and optimal cut points according to receiver operating characteristics were calculated.
In all samples, we found excellent item-total correlations and internal consistencies for the DSI-SS. Zero-order correlations between the DSI-SS and theoretically related constructs showed positive correlation coefficients, ranging from 0.50 to 0.67. The DSI-SS differentiated well between patients with and without suicide attempts in the population-based sample, but less so in the inpatient sample and only marginally in the outpatient sample. A bootstrapping analysis showed some variability in the cut points that emerged as optimal, but there was no overlap between the different samples.
The specific cut points that we identified may be used to improve the diagnostic utility of the DSI-SS and the chance to detect suicidal ideation.
Detection and resolution of conflicting change operations in version management of process models
(2013)
Version management of process models requires that different versions of process models are integrated by applying change operations. Conflict detection between individually applied change operations and conflict resolution support are integral parts of version management. For conflict detection it is utterly important to compute a precise set of conflicts, since the minimization of the number of detected conflicts also reduces the overhead for merging different process model versions. As not every syntactic conflict leads to a conflict when taking into account model semantics, a computation of conflicts solely on the syntax leads to an unnecessary high number of conflicts. Moreover, even the set of precisely computed conflicts can be extensive and their resolution means a significant workload for a user. As a consequence, adequate support is required that guides a user through the resolution process and suggests possible resolution strategies for individual conflicts. In this paper, we introduce the notion of syntactic and semantic conflicts for change operations of process models. We provide a method how to efficiently compute conflicts precisely, using a term formalization of process models and consider the subsequent resolution of the detected conflicts based on different strategies. Using this approach, we can significantly reduce the number of overall conflicts and reduce the amount of work for the user when resolving conflicts.
The establishment of successful clinical information logistics (CIL) within the care processes is one of the main objectives of strategic health IT management in hospitals. While technical realisations in terms of useful, usable and interoperable IT solutions are essential precursors of CIL, there is limited empirical research on what socio-organisational factors underlie an innovation-friendly culture and how they can affect successful information provision. We applied factor analysis on survey data from 403 clinical directors from Germany, Austria and Switzerland and used the dimensions identified to explain the level of CIL with ordered logistic regression analysis. The intensity of collaboration and exchange with the IT department as well as the degree of executive IT leadership showed to be strongly associated with better CIL while personal views and attitudes of clinical directors were not. Analysing country differences revealed the degree of the exchange with the IT department to be significantly lower in German hospitals. This points at a potential strategic lever for German hospital executives to focus on.
Objectives: This paper addresses recent steps for reforming the eligibility criteria of the German long-term care insurance that have been initiated to overcome shortcomings in the current system.
Methods: Based on findings of a survey of international long-term care systems, assessment tools and the relevant literature on care needs a new tool for determining eligibility in the German long-term care insurance was developed.
Results: The new tool for determining long-term care eligibility broadens the understanding of what ‚dependency on nursing care' implies for the person affected. The assessment results in a degree of dependency from personal help provided by formal or informal caregivers. This degree of dependency can be used for determining eligibility for and the amount of long-term care benefits.
Discussion: The broader understanding of "dependency on nursing care' and the new tool are important steps to adapt the German long-term care insurance to the challenges of the demographic and societal changes in the future
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.
Background: Continuous improvements of IT-performance in healthcare organisations require actionable performance indicators, regularly conducted, independent measurements and meaningful and scalable reference groups. Existing IT-benchmarking initiatives have focussed on the development of reliable and valid indicators, but less on the questions about how to implement an environment for conducting easily repeatable and scalable IT-benchmarks.
Objectives: This study aims at developing and trialling a procedure that meets the afore-mentioned requirements.
Methods: We chose a well established, regularly conducted (inter-) national IT-survey of healthcare organisations (IT-Report Healthcare) as the environment and offered the participants of the 2011 survey (CIOs of hospitals) to enter a benchmark. The 61 structural and functional performance indicators covered among others the implementation status and integration of IT-systems and functions, global user satisfaction and the resources of the IT-department. Healthcare organisations were grouped by size and ownership. The benchmark results were made available electronically and feedback on the use of these results was requested after several months.
Results: Fifty-ninehospitals participated in the benchmarking. Reference groups consisted of up to 141 members depending on the number of beds (size) and the ownership (public vs. private). A total of 122 charts showing single indicator frequency views were sent to each participant. The evaluation showed that 94.1% of the CIOs who participated in the evaluation considered this benchmarking beneficial and reported that they would enter again. Based on the feedback of the participants we developed two additional views that provide a more consolidated picture.
Conclusion: The results demonstrate that establishing an independent, easily repeatable and scalable IT-benchmarking procedure is possible and was deemed desirable. Based on these encouraging results a new benchmarking round which includes process indicators is currently conducted.
Every modern institution involved in higher education needs a Learning Management System (LMS) to handle learning and teaching processes. It is necessary to offer e.g. electronic lecture materials to the students for download via the internet. In some educational contexts, it is also necessary to offer internet tutorials to be able to give the students more personal support and accompany them through the whole lecture period. Many organisations have introduced commercial LMS and gained the experience that monolithic solutions do not fulfil the dynamic requirements of complex educational institutions and are very cost-intensive. Therefore, many universities face the decision to stick to their commercial LMS or to switch to a potentially more cost-effective and flexible solution, for instance by adopting available Open Source LMS. Since we have made profound experience in developing and operating an Open Source LMS, this contribution enlightens the main characteristics of this alternative. This paper describes a use case dealing with a full product lifecycle (development, deployment, use and evaluation) of an Open Source LMS at the University of Muenster (Germany). It identifies relevant instruments and aspects of system design which software architects in practical application domains should pay attention to.
Background: Clinical information logistics is the backbone of care workflows inside and outside of hospitals. Due to the great potential of health IT to support clinical processes its contribution needs to be regularly monitored and governed. IT benchmarks are a well-known instrument to optimise the availability and use of IT by guiding the decision making process. The aim of this study was to translate IT benchmarking results that were grounded on a hierarchical workflow scoring system into an appropriate visualisation concept.
Methods: To this end, a three-dimensional multi-level model was developed, which allowed the decomposition of the highly aggregated workflow composite score into score views for the individual clinical workflows concerned and for the descriptors of these workflows. Furthermore this multi-level model helped to break down the score views into single and multiple indicator views.
Results: The results could be visualised per hospital in comparison to the results of organisations of similar size and ownership (peer reference groups) and in comparison to different types of innovation adopters. The multi-level model was implemented in a benchmark of 199 hospitals and evaluated by the chief information officers. The evaluation resulted in high ratings for the comprehensibility of the different types of views of the scores and indicators.
Conclusions: The implementation of the multi-level model in a large benchmark of hospitals proved to be feasible and useful in terms of the overall structure and the different indicator views. There seems to be a preference for less complex and familiar views.
Introduction
Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.
Method
A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.
Results
The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.
Discussion
Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.
Extending assessments of climate change-induced range shifts via correlative species distribution models by including species traits is crucial for conservation planning. However, comprehensive assessments of future distribution scenarios incorporating responses of biotic factors are poorly investigated. Therefore, the aim of our study was to extend the understanding about the combined usage of species traits data and species distribution models for different life stages and distribution scenarios. We combine global model predictions for the 2050s and thermal performances of Salmo trutta and Salmo salar under consideration of different life stages (adults, juveniles, eggs), timeframes (monthly, seasonally, yearly), and dispersal scenarios (no dispersal, free dispersal, restricted dispersal). We demonstrate that thermal performances of different life stages will either increase or decrease for certain time periods. Model predictions and thermal performances imply range declines and poleward shifts. Dispersal to suitable habitats will be an important factor mitigating warming effects; however, dams may block paths to areas linked to high performances. Our results emphasize enhanced inclusion of critical periods for species and proper dispersal solutions in conservation planning.
Differentiating nociceptive and neuropathic components of clinical pain presentations matters!
(2016)
Aims:
To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.
Methods:
A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the ‘gold standard’ for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.
Results:
A total of 43 (49%) children (aged 6–18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.
Conclusion:
The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
Background:
While aiming for the same goal of building a national eHealth Infrastructure, Germany and the United States pursued different strategic approaches – particularly regarding the role of promoting the adoption and usage of hospital Electronic Health Records (EHR).
Objective:
To measure and model the diffusion dynamics of EHRs in German hospital care and to contrast the results with the developments in the US.
Materials and methods:
All acute care hospitals that were members of the German statutory health system were surveyed during the period 2007–2017 for EHR adoption. Bass models were computed based on the German data and the corresponding data of the American Hospital Association (AHA) from non-federal hospitals in order to model and explain the diffusion of innovation.
Results:
While the diffusion dynamics observed in the US resembled the typical s-shaped curve with high imitation effects (q = 0.583) but with a relatively low innovation effect (p = 0.025), EHR diffusion in Germany stagnated with adoption rates of approx. 50% (imitation effect q = -0.544) despite a higher innovation effect (p = 0.303).
Discussion:
These findings correlate with different governmental strategies in the US and Germany of financially supporting EHR adoption. Imitation only seems to work if there are financial incentives, e.g. those of the HITECH Act in the US. They are lacking in Germany, where the government left health IT adoption strategies solely to the free market and the consensus among all of the stakeholders.
Conclusion:
Bass diffusion models proved to be useful for distinguishing the diffusion dynamics in German and US non-federal hospitals. When applying the Bass model, the imitation parameter needs a broader interpretation beyond the network effects, including driving forces such as incentives and regulations, as was demonstrated by this study.
Radiology has a reputation for having a high affinity to innovation – particularly with regard to information technologies. Designed for supporting the peculiarities of radiological diagnostic workflows, Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) developed into widely used information systems in hospitals and form the basis for advancing the field towards automated image diagnostics. RIS and PACS can thus serve as meaningful indicators of how quickly IT innovations diffuse in secondary care settings – an issue that requires increased attention in research and health policy in the light of increasingly fast innovation cycles. We therefore conducted a retrospective longitudinal observational study to research the diffusion dynamics of RIS and PACS in German hospitals between 2005 and 2017. Based upon data points collected within the “IT Report Healthcare” and building on Rogers’ Diffusion of Innovation (DOI) theory, we applied a novel methodological technique by fitting Bayesian Bass Diffusion Models on past adoption rates. The Bass models showed acceptable goodness of fit to the data and the results indicated similar growth rates of RIS and PACS implementations and suggest that market saturation is almost reached. Adoption rates of PACS showed a slightly higher coefficient of imitation (q = 0.25) compared to RIS (q = 0.11). However, the diffusion process expands over approximately two decades for both systems which points at the need for further research into how innovation diffusion can be accelerated effectively. Furthermore, the Bayesian approach to Bass modelling showed to have several advantages over the classical frequentists approaches and should encourage adoption and diffusion research to adapt similar techniques.
Symposion: Working for the greater good in services: risks and innovation impacts on employees’ wellbeing
Oral presentation: Kumbruck: Digitalization in Health and Old People’s Care and the Impacts on the Interaction Work
Purpose: Digitalization like roboter to lift or feed care receiver or like electronic patient documentation, e.g. on smartphones, changes interaction and communication between care givers and care receivers. From our research projects (Projektgruppe verfassungsverträgliche Technikgestaltung: Mobile information and communication tools in the hospital; Das Ethos fürsorglicher Praxis in der Pflege) shows impacts.
Design/Methodology/Approach/Intervention: Qualitative studies (simulation studies; narrative Interviews, observations,) with more than 60 experimentees in different health care institutions.
Results: The interaction is mediated by electronic tools. The nurses are confident by the electronic assistance and workload reduction; but they are afraid of more distance in the relationship to the patients, more mixing of private and working time activities or more observation by their superiors. The most critical aspect is seen in the patient documentation.
Limitations: These studies are explorative ones. Especially the simulation study is an experimental design.
Research/Practical Implications: There is need for more and quantitative studies. The results give a lot of indications that the organizational and political frameworks of health care are important moderators of the impacts of the digitalization in health care.
Originality/Value: The studies have an important perspective on the change in the relationship between health care givers and receivers by digitalization – a topic, which concerns everybody.
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.
Do multipliers have to be more sensitized for the issue diversity? Do they have to develop specific competences? Which do they already have? These questions were analysed by a qualitative investigation. Ca. 70 interviews with managers of the large DAX companies and employees were conducted. The results show a field of tension between self-perception and perception of others and the assessment of the relevance of diversity attitudes and measures, competences and their actual implementation. The results indicate the need of promotion of competences, especially regarding the intercultural competence. We position ourselves in a functionalist perspective, in line with the work on paradigms of Burell and Morgan (2017) and Deetz (1996) in social sciences and Cross-Cultural Management. We present these results from a functionalist perspective in order to ensure the greatest possible "objectivity".
The central aim of the investigation at hand is to deal with the problem areas of Human Resource Management, which arise by demographic changes and migration. The paper focuses on mutual relationships. Managers and human resource managers are considered as multipliers. Older employees, migrants and women are important potential. Therefore, following research questions have been investigated: Which competences are necessary to promote to recognise the potential of migrants correctly and to promote them? Do the multipliers have to be more sensitized for the issue diversity? Do they have to develop specific competences to make the system more permeable and to make the entry and promotion of migrants possible? Which competences should be promoted to increase the sensitivity for diversity? The questions were examined by a qualitative investigation to develop hypotheses for a quantitative study. Overall, 30 interviews with managers, human resource managers and diversity representatives of the large DAX companies were conducted. Furthermore, 17 employees with immigration background and 15 employees without an immigration background were interviewed. The data was transcribed and analysed by the qualitative content analysis according to Mayring (2010). Comparative analyses were made with single items with Likert Scales. The investigation of managers and employees is a highly diversified issue. Therefore, the main focus of the project lays on the problem areas, conflicts and competences of human resources managers in demographic-sensitive personnel management. In comparison, employees with and without an immigration background were asked. The results show an interesting field of tension between self-perception and perception of others and the assessment of the relevance of diversity attitudes and measures, competences and their implementation. Furthermore, a contrary perception regarding strains and stresses of person with and without immigration background is determined, which is developed in the consequences of migrations stress and experiences of discrimination. The results indicate the need of promotion of competences, especially regarding intercultural competence. A critical analysis of the results will be presented.
Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women.
The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment.
A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined.
After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p < 0.001/d = 0.756). In contrast, only an average improvement of 0.1681 mm (p = 0.397) was shown in the PG, while the CG showed a slight improvement of 0.0139 mm (p = 0.861). However, no significant changes were observed with regard to the lumbar flexion and mechanosensivity of the treated muscles.
Thus, evidence is that the use of Foam Roll exercises significantly improves the mobility of the thoracolumbar fascia in a healthy young population.
Purpose
In a knowledge-based society, one of the main driving forces of prosperity at city and regional levels is the ability to attract students and recently qualified graduates. The purpose of this paper is to identify the urban factors that contribute to “attractiveness” from a student perspective and to subsequently analyse the influence of these factors on students’ location choices. In the corresponding case study, the criteria identified were used to evaluate student satisfaction with the German city of Osnabrück.
Design/methodology/approach
A multi-level empirical research concept was used to analyse the relevant criteria. Focus group discussions served as the basis to design and conduct a survey of almost 2,300 students in the university city of Osnabrück at the end of 2016. A follow-up study in November 2017 at two universities in Berlin provided data for comparison.
Findings
Accessible – safe – clean and with affordable housing: these terms sum up the core expectations that students have of an attractive city. In contrast to the findings of Richard Florida regarding the creative class, cultural opportunities, exciting nightlife and a multicultural population were not important factors among the survey participants.
Research limitations/implications
As the study was conducted in two cities only, the findings cannot be generalised. It should be replicated in at least five other cities to validate and compare the research findings presented here. Furthermore, this study focused on the factors influencing the attractiveness of the city as a whole. However, the attractiveness of a specific neighbourhood may be of greater relevance to the decision-making process. As housing plays a major role, students’ particular needs with regard to accommodation should also be examined at greater depth.
Practical implications
Insights generated by the empirical study provide relevant information that may assist city stakeholders in taking effective measures regarding place management to attract and retain students.
Originality/value
To date, little research has been undertaken to empirically examine the specific factors that German students look for when deciding where to study and live. The goal of this paper is to present new empirical insights concerning the quality-of-life factors that influence students’ decision-making processes.
Objective
Gross mandibular position and masticatory muscle activity have been shown to influence cervical muscles electromyographic activity. The purpose of this study was to investigate the influence of three different mandible positions including conscious occlusion, tongue tip against the anterior hard palate (Palate tongue position) and natural resting position (Rest), on sagittal plane cervical spine range of motion (ROM) as well as the flexion-rotation test (FRT) in asymptomatic subjects.
Materials and methods
An experienced single blinded examiner evaluated ROM using an Iphone in 22 subjects (7 females; mean age of 29.91years, SD 5.44).
Results
Intra-rater reliability for range recorded was good for the FRT with ICC (intraclass correlation) 0.95 (95% CI: 0.88–0.98) and good for sagittal plane cervical ROM with ICC 0.90 (95% CI: 0.77–0.96). A repeated measures ANOVA determined that mean ROM recorded during the FRT differed significantly between assessment points (F(1.99, 41.83) = 19.88, P < 0.001). Bonferroni Post hoc tests revealed that both conscious Occlusion and Palate tongue position elicited a significant large reduction in ROM recorded during the FRT from baseline (p < 0.01). Despite this, one activation strategy did not influence ROM more than the other. An additional repeated measures ANOVA determined that mean sagittal cervical ROM did not significantly vary between assessment points (F(2, 42) = 8.18, P = 0.08).
Conclusion
This current study provided further evidence for the influence of the temporomandibular region on upper cervical ROM. Results suggest that clinicians should focus on the natural mandible rest position when evaluating upper cervical mobility.
A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.
When speaking about eBusiness as applied to the healthcare market two questions arise immediately. Firstly, what is eBusiness? Secondly, why is eBusiness in healthcare different from eBusiness in other sectors?
Within the arena of eBusiness in healthcare, the focus is on purchasing and selling online as the most advanced application. In this book, the Authors consider both the perspective of the healthcare providers and that of the suppliers, showing the interdependencies between the two and developing concepts for a new synergistic cooperation.
eBusiness in Healthcare raises awareness of and interest in electronically mediated business processes in healthcare to a large audience including healthcare informaticians, medical business managers, clinicians, pharmacists and scientists. By taking an international approach to the topic the authors demonstrate the many similarities of eBusiness problems and their solutions among different countries which permits analysis of the differences that are often defined by the national healthcare systems and their rules. Case studies from healthcare institutions and from suppliers in the US, the UK and Germany will illustrate the achievements, barriers and future plans, thus enabling newcomers to learn from previous experience.
Clinicians will gain significant insight by this book which demonstrates the interconnection between patient care processes and management issues at the level of medical supplies. The book also makes a plea for a multidisciplinary effort, to enable the right product to be procured for the right patient. As a rather new discipline, eBusiness in healthcare needs further scientific backing. Against this background, this book will not only provide answers but will also raise questions for future research. Managing change and innovation and establishing the critical mass for eBusiness in healthcare is a major undertaking. The aim of this book is to support this process.
Introduction
Observations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility.
Method
This study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM).
Results
The sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result.
Conclusion
The use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.
In recent years, the issue of land consumption or land use has become increasingly important in many areas of our society. Logistics processes in particular take up a lot of space and have a significant impact on the environment. The question is how this use of land can be optimised. Based on a systematic literature review and interviews with experts in the period between May 2021 and July 2021, this paper presents indicators that constitute or influence space-efficient logistics in the context of cooperation. The results show that in addition to the established cooperation characteristics, there are other indicators that are directly related to land use. In the logistics sector, there is strong competitive pressure and, as a result, little trust between companies. It has been shown that with the help of a neutral moderator, the gap between trusting, land-efficient cooperation and one’s own entrepreneurial interests can be narrowed, and cooperation can be profitable for all participants. In addition, digitisation actually does not seem to be sufficient to meet the information needs of a cooperation. The exchange of information not only serves to automate processes, but also makes cooperation more transparent. It shows that legal and municipal requirements need to be developed. It also becomes clear that the indicators have a mutual influence on each other and cannot be considered in isolation when it comes to the actual implementation of a cooperation. By increasing the efficiency of cooperative processes and value creation, it offers the opportunity to make land use more sustainable.