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German farmers are required by law to regularly self-assess the welfare of their animals. The project Q Check is aiming at developing a system that will assist farmers to objectively assess animal health and welfare in dairy cows. For this reason, a quarterly report will be compiled from animal-based key indicators to give an overview of the on-farm situation. The anonymised and aggregated reports can also be used for national animal welfare monitoring: Continuous collection of these key indicators enables the summary and publication of figures reflecting the current animal health and welfare status and progressions at federal state and at national level. Q Check is based on four data recording and analysis systems, which are already established in Germany and implemented on a national level. Out of these systems, the most suitable indicators to describe herd health have been selected by 215 experts within a twostage Delphi study. In addition, over 50 face-to-face interviews with stakeholders related to the German dairy sector have been performed in order to take into account the socio-scientific point of view. To complete the process, the selected indicators are currently being checked against mass data and hence tested for suitability regarding monitoring purposes. An automatic farm-specific evaluation of animal health, based on verified indicators, will provide support to farmers in fulfilling their legal requirements and in identifying weak points on the individual farms. A benchmarking system will be set up which will allow tracking the individual herd health indicators in the same farm in their course over time and compared with similar farms. These routinely provided horizontal and vertical statistics will facilitate targeted intervention and support objectified management decisions, implying that dairy farmers can benefit in several respects. In the course of the project, new tools for determining the risk of ketosis in the scope of milk recording will also be validated and implemented at national level to enhance monitoring of this major disease complex. The results of these nationwide, systematic investigations will contribute substantially to objectifying the discussion about the health and welfare situation of dairy cows.
This study identifies and evaluates factors for success in innovation work in the Bavarian dairy farming industry. The research is based on an analysis of innovation system theories and a comparison with innovation work in the Dutch dairy sector. Dutch dairy farming is characterized by high productivity and technical efficiency at the farm level. Moreover, important developments in dairy farming have originated in the Netherlands. Therefore, this study delves into the systemic background of the successful innovation work in the Netherlands and makes a comparison with Bavaria. The main result of this study is that innovation work in the Bavarian dairy farming sector is lacking in two respects: end-user (farmer) integration and within-sector cooperation.
Auch um die Milchviehhaltung gibt es seit einigen Jahren eine öffentlich geführte Tierwohldiskussion. Zwei Aspekte sind dabei immer wieder Gegenstand der Kommunikation: Die Anbindehaltung und der Weidegang. Auf Basis von qualitativen Interviews mit zivilgesellschaftlichen Verbänden und landwirtschaftlichen Verbänden wurden die Einstellungen und die Argumentationsmuster beider Verbandsgruppen zu den Haltungsformen Weidegang und Anbindehaltung ergründet. Von Interesse ist dieser Vergleich, da im Rahmen öffentlich-medialer Kommunikation die Diskussionsfronten zwischen beiden Verbandsgruppen verhärtet erscheinen. Die Analyse der Aussagen, die im Rahmen der qualitativen Interviewreihe dieser Studie getätigt wurden, erlaubt die begründete Annahme, dass beide Verbandsgruppen mit den Themenkomplexen Anbindehaltung und Weidehaltung in einem wissenschaftliche orientierten Kommunikationskontext differenziert umgehen. Eine klare Polarisierung der Einstellungen zwischen beiden Verbandsgruppen ist in einem solchen Umfeld nicht mehr wahrnehmbar gewesen.
Gebäude beanspruchen Ressourcen und verändern die Umwelt. Die Landwirtschaft benötigt oftmals großvolumige Gebäude. Eine nachhaltigere landwirtschaftliche Baukultur wäre damit begrüßenswert. Für das agrarische Bauen könnte eine verstärkte Verwendung des Rohstoffs Holz eine Perspektive darstellen. Holz überzeugt durch zahlreiche ökologische Vorteile wie die langfristige Kohlenstoffbindung oder eine einfache Recycelbarkeit. In Deutschland spielt Holz allerdings beim landwirtschaftlichen Bauen eine immer geringere Rolle. Diese Studie stellt Meinungsbilder deutscher LandwirtInnen zusammen zum Holzeinsatz beim Stallbau. Es wurden zehn Gruppendiskussionen gestaltet zum Themenfeld landwirtschaftliche Baukultur in verschiedenen deutschen Schwerpunktregionen der Rinderhaltung. Die Auswertungen zeigen, dass die LandwirtInnen weitestgehend die optische Wirkung von Holz schätzen, aber häufig an der Dauerhaftigkeit von Holzställen zweifeln.
Design knowledge on smart glasses-based systems is scarce. Utilizing literature analysis on software development publications, insights from the design and implementation of four smart glasses-based systems and expert interviews, we elicited 16 design principles to provide guidance in the development of future service support systems. Heuristic Theorizing is an abductive Design Science Research method, hitherto far too little known or little noticed, which was applied to conduct the research. We contribute to theory and practice with applicable design principles to support the development of smart glasses-based systems. Phenomena known to have an impact on the adoption of smart glasses are addressed by these design principles.
A structured hospital discharge management process can lead to a smoother transition to aftercare. In practice, providing continuity of nursing care after a stationary hospital stay is accompanied by numerous challenges. The presented study aims to point out the use cases and requirements for an IT system supporting the diverse tasks of the participating actors. Within the scope of a multi-method research design, the authors conducted and analysed stakeholder interviews, a shadowing, a systematic literature search and statutes in order to gain the presented results. This publication presents 37 requirements, grouped to 14 use cases. A process model in BPMN visualises the discharge management process. Further, the authors derived implications for practice and research. These can be used for the development, classification and assessment of IT systems. Therefore, this publication provides a significant contribution to the development of socio-technical systems within the health care domain.
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.
Personal health records (PHR) are instruments to compile, store and present health and wellness related data digitally with proven effects on self-management of diseases. The aim of this study was to investigate whether there were differences in the intention to use (ITU) and perceived usefulness (PU) of two technologies allowing users to access the PHR, i.e. a kiosk system and a smart phone based app (access as usual). The study also aimed at modelling ITU and PU with multiple linear regressions. A total of 46 subject participated in the study who were randomly assigned to one of the two experimental groups (nkiosk = 22; napp = 24). The task for both groups was to digitise their “Medikationsplan” (medical record) and upload it to the PHR. There was no significant difference in ITU and PU between the two technologies. ITU could only be significantly explained by PU (R2 = .55, p < 0.001), while PU was determined by perceived ease of use and psychological factors (R2 = .64, p < 0.001). Severity of disease did not play any significant role. The German “Terminservice- und Versorgungsgesetz” underpins the importance and timeliness of this study. The assumption that both – the publicly accessible kiosk and the app – are equally acceptable for people of different gender, age and technology background demonstrates the opportunity to master a potential digital divide among the population and allows users to get access to their PHR in multiple ways.
Use of Emergency Departments by Frail Elderly Patients : Temporal Patterns and Case Complexity
(2019)
Emergency department (ED) care for frail elderly patients is associated with an increased use of resources due to their complex medical needs and frequently difficult psycho-social situation. To better target their needs with specially trained staff, it is vital to determine the times during which these particular patients present to the ED. Recent research was inconclusive regarding this question and the applied methods were limited to coarse time windows. Moreover, there is little research on time variation of frail ED patients’ case complexity. This study examines differences in arrival rates for frail vs. non-frail patients in detail and compares case complexity in frail patients within vs. outside of regular GP working hours. Arrival times and case variables (admission rate, ED length of stay [LOS], triage level and comorbidities) were extracted from the EHR of an ED in an urban German teaching hospital. We employed Poisson time series regression to determine patterns in hourly arrival rates over the week. Frail elderly patients presented more likely to the ED during already high frequented hours, especially at midday and in the afternoon. Case complexity for frail patients was significantly higher compared to non-frail patients, but varied marginally in time only with respect to triage level and ED LOS. The results suggest that frailty-attuned emergency care should be available in EDs during the busiest hours. Based on EHR data, hospitals thus can tailor their staff needs.
Despite similar policy goals, the adoption of eHealth practices took different paths in Austria (AT), Switzerland (CH), and Germany (GER). We seek to provide a rigorous analysis of the current state of hospitals by focusing on three key eHealth areas: electronic patient records (EPR), health information exchange (HIE), electronic patient communication. For validation and in order to gain better contextual insight we applied a mixed method approach by combining survey results from clinical directors with qualitative interview data from eHealth experts of all three countries. Across countries, EPR adoption rates were reported highest (AT: 52%, CH: 78%, GER: 50%), HIE-rates were partly lower (AT: 52%, CH: 14%, GER: 17%), and electronic patient communication was reported lowest overall (AT: 17%, CH: 8%, GER: 19%). Amongst others, results indicate patient awareness about eHealth to be equally weak across countries, which thus may be an important focal point of future policy initiatives.
This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.