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Die Arbeit mit Sinus-Milieus ermöglicht den Akteuren in Stadtentwicklungsprozessen bereits ein deutlich verbessertes Verständnis der Lebenswelt unterschiedlicher Zielgruppen und damit eine höhere Effektivität von Maßnahmen. Gleichwohl fällt es vielen schwer, die umfangreichen Milieudaten auf ihre konkreten Fragestellungen anzuwenden. In einem Pilotprojekt in Cloppenburg wurde dieser Prozess in umgekehrter Reihenfolge vollzogen. Ausgangspunkt war der Auftakt eines Dachmarkenprozesses, der in Cloppenburg 1 als integraler Bestandteil der Stadtentwicklung begriffen wird.
Was erwarten Studierende von Städten? : Freunde und Familie wichtiger als Karriere und Status
(2016)
Dieses Lehrbuch vermittelt fundiert und gut verständlich die theoretischen Grundlagen des öffentlichen Marketing. Stefanie Wesselmann und Bettina Hohn zeigen auf, wo eine Übertragung des (privatwirtschaftlichen) Marketing auf den öffentlichen Sektor sinnvoll ist. Vielfältige Praxisbeispiele aus öffentlichen Verwaltungen, Städten und Gemeinden sowie aus Nonprofit-Organisationen veranschaulichen, wie Marketing zur Verbesserung der Kundenorientierung beitragen kann. Die 4. Auflage wurde vollständig überarbeitet und um ein neues Kapitel zum Markenmanagement und eine Case Study erweitert.
Der Inhalt - Grundbegriffe des Marketing- Stadtmarketing als Antwort auf den Städtewettbewerb- Marketing-Prozess- Case Study: Entwicklung einer Stadtmarke mit Hilfe von Design Thinking- Fundraising - Spenden und Sponsoring im Public Marketing- Qualitätsmanagement
Der öffentliche Sektor steht unter anhaltendem Reformdruck und muss sich verstärkt auf die Bedürfnisse unterschiedlicher Zielgruppen einstellen. Das betriebswirtschaftliche Marketing-Management bietet für diesen Reformprozess ein enormes Unterstützungspotenzial, allerdings nur, wenn die Spezifika des öffentlichen Sektors auch genügend beachtet werden. Stefanie Wesselmann und Bettina Hohn entwickeln gut verständlich und anhand vielfältiger Praxisbeispiele eine Marketing-Konzeption für den öffentlichen Sektor. Mit Übungsaufgaben zur Überprüfung des eigenen Wissens. Die 3. Auflage wurde überarbeitet und erweitert. Neue Beispiele veranschaulichen wesentliche Aspekte des Inhaltes.
Zwischen Bologna und Hsinchu : Die Entdeckung der Wissenschaftsstadt durch Kommunalverwaltungen
(2011)
Städte schenken ihren vorhandenen Wissensressourcen zunehmende Aufmerksamkeit und binden sie strategisch in kommunale Wachstumsstrategien ein. „Bürgermeister, Kommunalpolitiker sowie Hochschul- und Institutsleiter versuchen durch die Teilnahme an Wettbewerben wie Stadt der Wissenschaft oder durch Aufgreifen von Knowledge City-Strategien, bisher brachliegende Potentiale für die Stärkung der lokalen Wirtschaft in den Dienst zu nehmen.“(Franz 2004, S. 95).
Spätestens seit der breiten Rezeption, die das 2002 erschienene Buch von Richard Florida (The Rise of the Creative Class) erfahren hat, ist die Bedeutung von Wissenschaft und Kreativität für die Stadtentwicklung in vielen Kommunen erkannt worden. Städte und Regionen konkurrieren in zunehmend globalem Maßstab um Hochqualifizierte, um die Ansiedlung von Hochschulen, Forschungseinrichtungen und um innovative Unternehmen. Deshalb versuchen sich viele Kommunen mittlerweile als Wissenschaftsstandort zu profilieren. Die Autorin geht der Frage nach, was eine Wissenschaftsstadt von einem Wissenschaftsstandort unterscheidet und welche unterschiedlichen kommunalen Strategien sich in diesem Feld unterscheiden lassen.
Die ökologischen Auswirkungen des ökonomischen Wachstums zählen zu den größten Problemen unserer Gesellschaft. Als Reaktion auf diese ökologischen Herausforderungen hat sich im Eventmarkt in den letzten ca. 20 Jahren das Konzept der „Green Meetings“ entwickelt. Durch diese Veranstaltungsform sollen die Auswirkungen einer durchgeführten Veranstaltung auf die Umwelt möglichst gering gehalten werden. Im Rahmen einer Literaturanalyse werden fünf verschiedene Untersuchungsschwerpunkte identifiziert, mit denen sich „Green Meetings“ erklären lassen. Aus jedem dieser Ansätze geht ein sehr unterschiedliches Verständnis von Green Meetings hervor. Dabei wird ersichtlich, dass in der Vergangenheit insbesondere die multiple Wirkung von Veranstaltungen im Vordergrund der Analysen stand. Neuere Ansätze helfen, Green Meetings holistischer zu erklären und greifen dabei auf das Konzept der Nachhaltigkeit oder des Stakeholder- und Netzwerk-Ansatzes zurück. Die Ergebnisse verdeutlichen, dass zum einen die ökologische Perspektive von Green Meetings vertiefender analysiert werden sollte. Zum anderen sollte der ökologische Blickwinkel von Green Meetings stärker um soziale und ökonomische Aspekte erweitert und die Zusammenhänge intensiver untersucht werden. Auf Basis der Literaturanalyse wird empfohlen, den Begriff „Green Meetings“ durch „nachhaltige Veranstaltungen“ zu ersetzen, da letzterer die Komplexität und Ganzheitlichkeit des Konzeptes adäquater umschreibt. Abschließend wird ein neues Definitionsverständnis von „nachhaltigen Veranstaltungen“ vorgeschlagen, das die verschiedenen Forschungsansätze integriert und einen holistischen Erklärungsansatz bietet.
Wie können Bildung und Wissenschaft am Standort für die regionale Entwicklung genutzt werden? Welchen Beitrag können die Kommune, Hochschulen und Forschungseinrichtungen, Unternehmen und Stiftungen, Vereine, Schulen und Kultureinrichtungen leisten, um die Stadt zu einem lebendigen und attraktiven Wissenschaftsstandort zu machen? Diesen Fragen geht die vorliegende Publikation nach und erteilt 16 deutschen Städten das Wort. Sie skizzieren, wie sie sich als Wissenschaftsstädte zu positionieren versuchen und welche Wege sie gehen, um Bildung und Wissenschaft in den Fokus ihrer Stadt und der Partner in Wirtschaft und Wissenschaft zu rücken. Auch Vertreter aus ansässigen Unternehmen und den Medien kommen zu Wort und beschreiben ihren Beitrag zu der Entwicklung.
Den Hintergrund für diese Praxisbeispiele bildet eine theoretische Einführung. In ihr werden die Grundlagen der Wissensökonomie und ihre Bedeutung für Städte beleuchtet, Ergebnisse einer empirischen Untersuchung des Wettbewerbs "Stadt der Wissenschaft" vorgestellt und auf der Grundlage der Praxisbeispiele aus den 16 Städten vier dominante Strategiemuster entwickelt. Zum Abschluss schauen wir über den Tellerrand und nehmen andere Städte in Europa in den Blick.
In einem vielbeachteten Gutachten des Wissenschaftlichen Beirats der Bundesregierung (WBGU) im Jahr 2011 wird ein notwendiger Transformationsprozess zu einer klimafreundlicheren Gesellschaft angemahnt (WBGU 2011). Im Jahr 2014 wird diese Forderung im Sondergutachten Klimaschutz als Weltbürgerbewegung aktualisiert (WBGU 2014). Studien verdeutlichen, dass viele Unternehmen in den letzten Jahren diesem geforderten Transformationsprozess nur sehr langsam und einseitig nachgehen. Danach sind nachhaltige Verhaltensweisen scheinbar nur dann relevant, wenn sie dem Unternehmen einen strategischen Wettbewerbsvorteil ermöglichen (Corporate Responsibility Index 2013). Werte und Normen von Unternehmensvertretern sowie deren gesellschaftlich verantwortungsvolles Handeln, verändern sich nur sehr strategisch. Das mag u. a. daran liegen, dass in der Vergangenheit primär technische Innovationen, z. B. effizientere Motoren, im Mittelpunkt standen, um den Transformationsprozess zu unterstützen und weniger die Veränderung von Einstellungen und Verhalten der Individuen (Stengel 2011). In den letzten Jahren haben jedoch soziale Innovationen (z. B. Sharing‐Economy) mit dem Ziel an Bedeutung gewonnen, die Ressourceneffizienz zu erhöhen. Ergänzend zeigen sich vielfältige Potenziale, wie sich gesellschaftliche Veränderungen durch innovative Formen der Kooperation, z. B. Reallabore, voranbringen lassen.
Greenwashing, defined by the Oxford Dictionary as “disinformation disseminated by an organization so as to present an environmentally responsible public image” can cause multifarious problems for companies. The phenomenon of greenwashing has, however, not attracted much attention in the event marketing literature to date. The purpose of this paper is twofold. It first describes and analyses the specific characteristics and features of greenwashing in event marketing. It then seeks to identify the current fundamental approaches of how to avoid greenwashing in event marketing and to assess their potential. A two-step literature analysis with complementary search approaches served as a methodical framework. First, journals related to event marketing were screened for the keywords “greenwashing” and “greenwash”. Next, the general literature was consulted for the same keywords. The results clearly demonstrate that the subject of greenwashing has been widely neglected in the event literature. There appears to be no overall concept or approach that allows event actors to avoid greenwashing, albeit various individual initiatives exist. However, it also became clear that initiatives against greenwashing in event marketing can be developed and implemented in the short and long term, for example by integrating different stakeholders. Additional political and juridical efforts based on specific guidelines are also necessary to prevent greenwashing in the future. The study is the first one to provide a systematic approach to the topic of greenwashing in the context of event marketing, including relevant approaches for its avoidance. It can thus help practitioners to better detect and avoid greenwashing in the event industry and to guide similar research in the future.
Highlights • We investigate how peer learning impacts elite footballers' performance. • We interview twelve elite footballers from German Bundesliga clubs. • Our findings highlight that peers are important knowledge sources in football. • Knowledge sharing positively impacts elite players' development and performance. • The findings call for management tactics to use this untapped potential. Abstract This research focuses on coworker learning and knowledge sharing amongst elite footballers. The authors provide an in-depth understanding on how elite footballers learn from their peers and which channels are used to share their knowledge. The authors also analyze how peer learning impacts an elite footballer's development and performance and to what extent elite football clubs actively support peer learning. Data were collected through semi-structured interviews with 12 elite footballers from first and second division German Bundesliga clubs. The findings demonstrate that peers are very important sources of knowledge for elite footballers. There are four main knowledge sharing channels: observing/imitating, peer exchange/peer communication, labor mobility and knowledge brokers. The findings highlight the positive impact of knowledge sharing on elite players' development and performance and call for future (knowledge) management tactics to specifically use this untapped potential.
Events are intangible services and services marketing thus plays a considerable role within event management education. The marketing mix with its “4 Ps” (product, price, promotion, place) is an essential element of many event management curricula. Most educational institutions also reflect the development (and related discussions) towards the existence of “7 Ps” – adding personnel, physical facilities and process management (Meffert/ Bruhn 2009) – or even “8 Ps” – adding physical environment, purchasing process, packaging and participation(Burke/ Resnick 2000) – within the service marketing domain.
Die alltägliche pädagogische Praxis von Grundschulen hat sich durch die Implementierung unterschiedlicher multiprofessioneller Kooperationsprozesse maßgeblich geändert (vgl. Beck & Maykus 2016, S. 148f.). So kooperieren laut Thieme (2019) seit dem Ausbau von ganztägig-inklusiven Schulsettings zunehmend auch Lehrkräfte und sozialpädagogische Fachkräfte unterschiedlicher Fachbereiche und Institutionen (vgl. Thieme, 2019, S. 247). Die Schulsozialarbeit an Grundschulen ist dabei ein sozialpädagogisches Arbeitsfeld, welches als Schnittstelle zwischen verschiedenen pädagogischen Berufsgruppen gilt (vgl. Thimm 2017, S. 108) und dem der Vernetzungs- und Kooperationsgedanken als Leitmotiv (sozial-)pädagogischer Praxis inhärent ist. Vor allem die Kooperation zwischen den Lehrkräften und der Schulsozialarbeit ist dabei an bestimmte Voraussetzungen geknüpft. Das BMBF-geförderte Forschungs- und Entwicklungsprojekt „Qualifizierungsmodule für die interprofessionelle Kooperation in inklusiven Grundschulen – Entwicklung und Evaluation des Manuals InproKiG“ (kurz: InproKiG) hat mit unterschiedlichen Erhebungsinstrumenten u.a. diese Voraussetzungen und Herausforderungen in der alltäglichen Kooperationspraxis näher analysiert. Der Beitrag stellt Ergebnisse einer quantitativen Erhebung zum Stand der Kooperation und zu Kooperationsbedarfen von Grundschulteams vor, welche in den Jahren 2018 und 2019 an Grundschulen in Hannover, Osnabrück und Gießen durchgeführt wurde. In Einzelanalysen werden vor diesem Hintergrund vertiefend die Perspektiven von Fachkräften der Schulsozialarbeit und ihre Erfahrungen interprofessioneller Kooperation untersucht.
Digitale Technologien lassen Daten im Berufsalltag von Beschäftigten im Gesundheitswesen allgegenwärtig werden. Diese Entwicklung stellt neue Herausforderungen an das Kompetenzprofil dieser Berufsgruppen, die sich unter dem Dachbegriff Datenkompetenz zusammenfassen lassen. Im vorliegenden Beitrag wird der Begriff vor dem Hintergrund der digitalen Transformation motiviert und definiert. Es wird eine zusammenfassende Sicht auf die Teilaspekte von Datenkompetenz gegeben und auf den derzeitigen Stand der systematischen Messung von Datenkompetenz eingegangen. Abschließend gibt der Beitrag eine Reihe von Handlungsempfehlungen, auf welche Weise Datenkompetenz im Rahmen der Weiterqualifikation von Beschäftigten vermittelt werden sollte.
Der primäre Einsatzzweck von Reifegradmodellen besteht zumeist in der reinen Inventarisierung der vorhandenen IT-Komponenten. Das vorliegende Kapitel gibt IT-Entscheider*innen in Krankenhäusern Empfehlungen, wie Reifegradmodelle für eine kontinuierliche Weiterentwicklung, Umsetzung und Evaluation von Digitalisierungsstrategien eingesetzt werden können. Als Prüfschema für die Auswahl geeigneter Verfahren werden neun Anforderungen an die Entwicklung und den Einsatz von Reifegradmodellen formuliert. Entlang von drei strategischen Handlungsfeldern – dem klinischen Anwendungsfeld, dem Informationsmanagement und dem organisatorischen Umfeld – werden dem Leser generische Digitalisierungsziele und dazugehörige Beispielindikatoren zur Erfolgskontrolle bereitgestellt.
Access to digital technologies depends on the availability of technical infrastructure, but this access is unequally distributed among social groups and newly summarized under the term digital divide. The aim is to analyze the perception of a tracing app to contain Covid-19 in Germany. The results showed that participants with the highest level of formal education rate the app as beneficial and were the most likely to use the app.
Artificial intelligence will change our lives permanently - both at work and in our private lives. But how does machine learning actually work? The authors explore this question in their English-language textbook. They teach the necessary basics for the use of support vector machines, for example, through linear programming, the Lagrange multiplier, kernels and the SMO algorithm. They also cover neural networks, evolutionary algorithms, and Bayesian networks. Definitions are highlighted in the book and assignments invite readers to think along. The textbook is aimed at students of computer science, engineering and natural sciences, especially in the fields of robotics, artificial intelligence, and mathematics.
Co-Creation in der Veranstaltungsbranche: Der Mehrwert von partizipativen Veranstaltungsformaten
(2021)
Das Konzept der Co-Creation hat sich zu einem vieldiskutierten Thema in der Veranstaltungsbranche entwickelt. Dieses Kapitel analysiert das Konzept von Co-Creation, auch vor dem Hintergrund ihrer Entstehung und Entwicklung im Rahmen der service-orientierten Sichtweise des Marketings. Ziel des Co-Creation-Ansatzes ist die Schaffung eines Mehrwertes für alle Beteiligten. Im Sinne eines gelungenen Wissenstransfers ist es für Veranstaltungs organisatoren dabei auch wichtig zu beachten, wie die Teilnehmer lernen und wie sie Informationen aufnehmen und behalten. Dazu werden verschiedene Lerntypen und Lernstile aus der Lernpsychologie vorgestellt. Die Ausführungen belegen die hohe Bedeutung von partizipativen Elementen, die somit neben den konventionellen Formaten (z. B. Frontalvorträgen) Bestandteil einer erfolgreichen Veranstaltung sein sollten. Das Kapitel stellt die prominentesten partizipativen Formate und deren Vor- und Nachteile vor und geht auch auf mögliche Herausforderungen bei der Umsetzung ein.
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
Building on Rogers’ Diffusion of Innovation Theory, Bass models describe the diffusion processes distinguishing between innovation (p) and imitation (q). This study aimed at modelling the uptake of RIS, PACS and EHR systems in Germany and Finland. The Bass models revealed a quick and almost identical uptake process across all three systems for Finland. In contrast, the Bass models mirrored a slower uptake in Germany. Consequently, the Finnish “imitation” coefficients were larger than the German ones. While in Germany almost free market forces were driving the adoption through imitation but without tail wind from policy, the adoption process in Finland was centrally governed. This suggests that the diffusion process in Finland reflected a well-managed roll-out of the systems rather than imitation behaviour. Thus, in order for Bass model coefficients to be understood properly, additional contextual information is required.
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
This paper provides a discourse based upon the key development of nursing in response to the emerging 4Ds of health technology re-design. Building informatics capability among health professionals is a workforce issue necessitated through the increasing prevalence of information technology and digitization of healthcare affecting the entire health workforce, specifically front-line nurses. The key concepts will be explored of Digitization, Distribution, Disruption and Diversity, a framework recognising the tsunami of technology such as Big Data analytics, comprehensive decision support systems for nursing, nanobots, robotics, and pharmacogenomics and the impact these have upon the nursing workforce.
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.
Differentiating nociceptive and neuropathic components of clinical pain presentations matters!
(2016)
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.