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Institute
- Fakultät WiSo (2129) (remove)
Frequent users of emergency departments (ED) pose a significant challenge to hospital emergency services. Despite a wealth of studies in this field, it is hardly understood, what medical conditions lead to frequent attendance. We examine (1) what ambulatory care sensitive conditions (ACSC) are linked to frequent use, (2) how frequent users can be clustered into subgroups with respect to their diagnoses, acuity and admittance, and (3) whether frequent use is related to higher acuity or admission rate. We identified several ACSC that highly increase the risk for heavy ED use, extracted four major diagnose subgroups and found no significant effect neither for acuity nor admission rate. Our study indicates that especially patients in need of (nursing) care form subgroups of frequent users, which implies that quality of care services might be crucial for tackling frequent use. Hospitals are advised to regularly analyze their ED data in the EHR to better align resources.
How do companies decide where to locate their manufacturing? This study uses insights from manufacturing company executives collected by means of in-depth interviews with 50 manufacturers in the United Kingdom to develop an understanding of manufacturing location decision making. The findings indicate that companies derive competitive advantage from organizing manufacturing in different ways. Retaining or reshoring manufacturing to a company’s home country can enhance new product development, control of quality, product customization, delivery performance, and cost leadership. On the other hand, companies can enhance new product development, customization, and delivery performance for new markets, if production facilities are offshored to or in proximity to these locations. In addition, some companies use a hybrid approach of offshoring the production of some components or products for cost arbitrage while retaining or reshoring other components or products for advantages from value chain integration. Based on the findings of this study, a set of key manufacturing location questions are developed that should be considered by firms pondering onshore, offshore, reshore, or hybrid manufacturing location decisions.
Background and purpose:
Clinical information logistics is a construct that aims to describe and explain various phenomena of information provision to drive clinical processes. It can be measured by the workflow composite score, an aggregated indicator of the degree of IT support in clinical processes. This study primarily aimed to investigate the yet unknown empirical patterns constituting this construct. The second goal was to derive a data-driven weighting scheme for the constituents of the workflow composite score and to contrast this scheme with a literature based, top-down procedure. This approach should finally test the validity and robustness of the workflow composite score.
Methods:
Based on secondary data from 183 German hospitals, a tiered factor analytic approach (confirmatory and subsequent exploratory factor analysis) was pursued. A weighting scheme, which was based on factor loadings obtained in the analyses, was put into practice.
Results:
We were able to identify five statistically significant factors of clinical information logistics that accounted for 63% of the overall variance. These factors were “flow of data and information”, “mobility”, “clinical decision support and patient safety”, “electronic patient record” and “integration and distribution”. The system of weights derived from the factor loadings resulted in values for the workflow composite score that differed only slightly from the score values that had been previously published based on a top-down approach.
Conclusion:
Our findings give insight into the internal composition of clinical information logistics both in terms of factors and weights. They also allowed us to propose a coherent model of clinical information logistics from a technical perspective that joins empirical findings with theoretical knowledge. Despite the new scheme of weights applied to the calculation of the workflow composite score, the score behaved robustly, which is yet another hint of its validity and therefore its usefulness.
Unternehmen verwenden heute bei der Umsetzung einer ökologieorientierten Unternehmenskommunikation in aller Regel sog. Effizienzstrategien (z. B. „effiziente, sparsame Maschinen“) oder aber sog. Konsistenzstrategien (z. B. „100 % recycelt“). Weitestgehend vernachlässigt wird bislang die sogenannte Suffizienzstrategie. Die suffizienzorientierte Kommunikation fokussiert im Gegensatz zu Effizienz- und Konsistenzstrategien auf einen konsumentenseitig genügsamen und umweltverträglichen Verbrauch von Material- sowie Energiemengen bei gleichzeitig steigendem individuellen Nutzenzugewinn bzw. einer steigenden Lebensqualität (z. B. „Carsharing: Und das Leben wird bunter, aufregender, vielfältiger.“). Die suffizienzorientierte Kommunikation fördert damit auch neue, veränderte Konsum- und Lebensweisen, die sich vom Hyperkonsum des 20. Jahrhunderts abwenden.
Der vorliegende Artikel widmet sich den Besonderheiten einer suffizienzorientierten Kommunikation. Es werden vier zentrale Ansatzpunkte zur Entwicklung einer suffizienzorientierten Unternehmenskommunikation vorgestellt und ihre wesentlichen Potenziale miteinander verglichen.
TÜV-Plaketten für Arztpraxen
(2005)
Musicians often suffer from disorders of the musculoskeletal system that are related to their instrument playing. Among the most frequent symptoms are complaints in the shoulder-neck area. Radial shock wave therapy is increasingly used in trigger point treatment, but only few high-level studies have examined of shock wave therapy used together with physical therapy in the treatment of musicians. METHODS: This randomized blinded study in musicians (n = 26) with nonspecific shoulder-neck problems was done to examine the effect of shock wave therapy in addition to current physical therapy on the symptoms and quality of life of the musicians as well as their habits of playing musical instruments (intervention group shock wave vs reference group placebo). The effects were documented by a pain VAS and other instruments. A questionnaire designed specifically for musicians (with initial and final questions) recorded intensity and manifestation of pain and handicaps in daily life, especially when practicing and playing. The Shoulder Pain and Disability Index (SPADI) and the Neck Pain Disability Index Questionnaire (NPDIQ) were also used. RESULTS: Both groups reported subjective improvement in pain, but significance was found only for the intervention group for the SPADI and NPDIQ. CONCLUSIONS: Trigger point treatment with radial shock wave used in combination with physical therapy makes the subjects feel temporarily relieved of neck and shoulder pains. The effects of radial shock wave without physical therapy will need to be examined in further studies.
Der Reisemarkt ist komplex, diversifiziert und schnelllebig: Viele Deutsche planen ihren Urlaub heutzutage eher kurzfristig, und sie suchen Alternativen zur gewohnten Reise zu Sonne, Strand und Meer. Die Anzahl der Reiseveranstalter und Spezialanbieter ist kaum mehr zu beziffern. Ständig erscheinen neue Trends und innovative Produkte. Das Internet stellt das traditionelle Geschäftsmodell der Reiseveranstalter auf den Kopf. Doch wie können Unternehmen Transparenz in einen komplexen Markt bringen und dessen Potenziale für das Management schlussendlich greifbar machen?
The article describes an analysis of the use of e-learning to improve the learning transfer to practice in continuing education. Therefore an e-learning offer has been developed as a part between two attendance periods of a training course in the field of Ambient Assisted Living (AAL). All participants of the course were free to use the e-learning offer. After the end of the e-learning part we compared the e-learning users to the other participants. Using an online questionnaire we explored if there are differences in the activities in the field AAL after the training course. The results show that e-learning is beneficial especially for communication processes. Due to the fact that the possibility to talk about the learning content is an essential factor for the learning transfer, e-learning can improve the learning success.
Trainingsgestaltung
(2010)
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.
This workshop will review the history of the TIGER initiative in order to set the framework for an understanding of international informatics competencies. We will include a description of clinical nursing informatics programs in 37 countries as well as the results of a recent survey of nursing competencies in order to further discussions of internationally agreed-upon competency definitions. These two surveys will provide the basis for developing a consensus regarding the integration of core competencies into informatics curriculum developments. Expected outcomes include building consensus on core competencies and developing plans toward implementing intra- and inter-professional informatics competencies across disciplines globally.
Informatics competencies of the health care workforce must meet the requirements of inter-professional process and outcome oriented provision of care. In order to help nursing education transform accordingly, the TIGER Initiative deployed an international survey, with participation from 21 countries, to evaluate and prioritise a broad list of core competencies for nurses in five domains: 1) nursing management, 2) information technology (IT) management in nursing, 3) interprofessional coordination of care, 4) quality management, and 5) clinical nursing. Informatics core competencies were found highly important for all domains. In addition, this project compiled eight national cases studies from Austria, Finland, Germany, Ireland, New Zealand, the Philippines, Portugal, and Switzerland that reflected the country specific perspective. These findings will lead us to an international framework of informatics recommendations.
Social networking technologies such as social media, crowd concepts, or gamification represent key resources for the integration of customers, value network partners, and the community into sustainable business models. However, there is a lack of understanding of how sustainable enterprises apply such technologies. To close this gap, we propose a taxonomy of design options for social networking technologies in sustainable business models. Our taxonomy comprises eight dimensions that deal with relevant questions of the design of social networking technologies. When creating our taxonomy, we built on existing literature and use cases and involved experienced practitioners in the field of sustainable business models for the validation of our taxonomy. In this way, our study contributes to knowledge on the use of social networking technologies in sustainable business models and how such technologies influence the boundaries of sustainable business models. Likewise, we provide practical insights into the use of social networking technologies in sustainable business models.
In the context of the ongoing digitization of interdisciplinary subjects, the need for digital literacy is increasing in all areas of everyday life. Furthermore, communication between science and society is facing new challenges, not least since the COVID-19 pandemic. In order to deal with these challenges and to provide target-oriented online teaching, new educational concepts for the transfer of knowledge to society are necessary. In the transfer project “Zukunftslabor Gesundheit” (ZLG), a didactic concept for the creation of E-Learning classes was developed. A key factor for the didactic concept is addressing heterogeneous target groups to reach the broadest possible spectrum of participants. The concept has already been used for the creation of the first ZLG E-Learning courses. This article outlines the central elements of the developed didactic concept and addresses the creation of the ZLG courses. The courses created so far appeal to different target groups and convey diverse types of knowledge at different levels of difficulty.
Too busy to think? : Essay über die spärliche Theoriebildung der deutschen Pflegewissenschaft
(2011)
Eine Synthetisierung pflegespezifischen Wissens in Gestalt von Theoriebildung fehlt im deutschsprachigen Raum weitgehend. Dies ist bedenklich, da die Pflege als Profession den Überformungsversuchen durch andere Wissenschaftsdisziplinen wenig entgegensetzen kann. Der spezifisch pflegewissenschaftliche Zugriff auf Gesundheitsprobleme kann dadurch nicht deutlich werden. Der Stand der Theorieentwicklung in einer Disziplin stellt einen guten Indikator für die geistige Verfassung dieser Disziplin dar. In allen Theoriesträngen ist festzustellen, dass nach den produktiven Entwicklungen der 1980er- und 1990er-Jahre der theoretische Diskurs im letzten Jahrzehnt beinahe zum Erliegen gekommen ist, während die Zahl empirischer Arbeiten sprunghaft ansteigt. Diese sollten in generalisierender und theoriebildender Absicht diskutiert werden. Ein Theoriediskurs müsste die theoretische Generalisierung von Forschungsbefunden leisten, um zu induktiver Theoriebildung zu gelangen. Induktive Theoriediskurse sollten wiederbelebt und die Patient(inn)enperspektive in Forschung und Theoriebildung gestärkt werden. Neue Aspekte gesundheitlicher Fragestellungen, wie etwa die demografische Entwicklung und ihre epidemiologischen Folgen, die Zunahme und der Gestaltwandel chronischer Krankheiten oder auch die Änderungen der Patientenrolle in Richtung Partizipation und Selbstmanagement verdienen theoretische Aufmerksamkeit. Die Wiederbelebung einer Diskurs- und Debattenkultur setzt jedoch voraus, dass ihr Zeit gewidmet werden kann. Erst dann wird das Lesen und Diskutieren empirischer und theoretischer Ergebnisse verwandter Disziplinen wieder auf der Agenda wissenschaftlichen Arbeitens erscheinen und - last but not least - damit eigene Theorieentwicklung möglich werden.
Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond.
In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER.
Teachers in health informatics have a broad variety of international and national educational recommendations to rely on when designing programmes, curricula, courses and educational material. However, in addition they often need very specific information for their setting, blue-prints, hands-on experience and encouragement to try something new. This workshop presents three case studies from European universities who have implemented inter-professional, technology enabled health informatics courses in undergraduate, postgraduate and open university settings. These approaches will be put into the context of the TIGER recommendation framework that includes priority ratings of health informatics competencies and case studies to illustrate them. The workshop attendees will have ample opportunity to exchange ideas with the presenters and start a mutual learning process for health informatics teachers.
Mit der Akademisierung von praktischen Gesundheitsberufen stehen die Hochschulen und Universitäten gleichermaßen vor der Herausforderung, Pflege- und Therapiekräfte für ein noch nicht definiertes Berufsfeld zu qualifizieren. Die Wissenschaft hat die Fragen nach den genauen Inhalten und der Abgrenzung akademisierter Gesundheitsberufe zu anderen, seit langem etablierten Tätigkeitsbereichen in der Patientenversorgung zu beantworten und weiterführend zukünftigen Entwicklungen aufzuzeigen. Hier erwächst der Bedarf nach einer weitergehenden Arbeitsforschung in den akademisierten, praktischen Gesundheitsberufen. Der in diesem Beitrag vorgestellte Ansatz kombiniert die Weiterqualifizierung mit der Arbeitsforschung im Berufsfeld. Ziel ist es, Weiterbildungsmodule zu konzipieren, bei denen das praktische Arbeitsfeld mit den jeweiligen Inhalten der Module systematisch in Bezug gesetzt wird. Grundlage hierzu sind didaktische Ansätze der Theorie-Praxis-Relation aus dualen Studiengängen. Zentrales Instrument ist eine reflexionsorientierte Fallstudie, die von den Teilnehmern der Weiterbildung für jedes Modul erstellt wird, in der die Teilnehmer theoriebasierte Inhalte des Moduls aufgreifen und dazu nutzen, ihr jeweiliges praktisches Arbeitsfeld mit der fachlichen Perspektive des Moduls zu reflektieren. Die Teilnehmer werden so zu Praxisforschern und die Weiterbildung gleichzeitig zu einer wissenschaftlichen Berufsfeldreflexion, aus der die Praxis Impulse zur Weiterentwicklung erhält.
The TIGER Initiative
(2016)
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.
Background: Lumbar discectomy is considered a safe, efficacious and cost-effective treatment for selected cases of patients with leg pain associated with the presence of a disc protrusion. But despite technically successful surgery, 30 % of patients complain of persistent pain on long-term follow up. Identification of possible predictors for a negative outcome is important, in the search for appropriate pre- and/or post-operative care and prevention of persistent disability. There is some evidence in the literature that quantitative sensory testing (QST) measures may play a role in prediction of patients’ pain persistency, however, this has never been investigated in patients undergoing lumbar discectomy.
Objective: The aim of this study is to determine the predictive value of QST parameters, in combination with previously documented predictor variables such as medical/psychological/cognitive behavioural factors, in patients with lumbar radiculopathy and/or radicular pain, for predicting patients’ clinical outcome after lumbar discectomy.
Method: Participants with radiculopathy and/or radicular pain and confirmed imaging diagnosis of nerve root compression will be recruited from the elective surgery waitlist at one hospital. All participants will undergo lumbar discectomy performed by one neurosurgeon. A standardized QST protocol comprising all of the somatosensory sub-modalities that are mediated by different primary afferents (C-, Aδ-, Aβ-) will be performed prior to surgery. QST will be conducted in the patients’ main pain area and contralateral side, in the affected dermatome and at a remote control site. The presence of other predictor variables will be captured by questionnaires. Follow-up at 3 months will include QST and measurements of pain intensity, pain descriptors, functional status, health related quality of life, return to work and health care utilisation. A further 1-year follow-up will include the same measurements except QST.
Results/Conclusions: Identification of new predictor variables may assist in the development of pre-surgical screening methods and in targeted pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability
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
Objectives
The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS).
Methods
This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner).
Results
Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034).
Conclusions
Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.
Thirty years ago, the Fourth King of Bhutan famously proclaimed that ―Gross National Happiness is more important than Gross National Product, thereby setting Bhutan on a holistic development path. Following this historic declaration, Bhutan developed a Gross National Happiness (GNH) Index and screening tool to evaluate all new policies, proclaiming that:
―Gross National Happiness measures the quality of a country in more holistic way [than GNP] and believes that the beneficial development of human society takes place when material and spiritual development occur side by side to complement and reinforce each other.
In July 2011, 68 nations joined Bhutan in co-sponsoring its UN General Assembly resolution on ―Happiness: Towards a Holistic Approach to Development.
Background: Muscle fatigue has been reported as a risk factor for the
development of performance-related musculoskeletal disorders (PRMD) in
musicians. However, little research exists to support this claim. The aim of
this study was to investigate whether changes occur in muscle activity
patterns during high string performance over a prolonged playing period, and
whether this is influenced by PRMD.
Methods: High string musicians were divided into a PRMD and a non-PRMD
group. They played a chromatic scale pre and post and a self-chosen “hard”
(Borg scale 16-17) piece of music for one hour. Electromyography data
recorded from arm, shoulder and trunk muscles was analyzed: the amplitude
to measure muscle activity characteristics and the lower frequency to
measure muscle fatigue. Differences between and within groups and the
frequency spectrum were analyzed using linear mixed models.
Results: Fifteen musicians participated (7 PRMD: 22.8 years, 2 male/5 female
and 8 non-PRMD: 34.3 years, 2 male/6 female). Changes in muscle activation
patterns were observed between and within both groups, however changes
varied significantly depending on group affiliation. Significant low frequency
spectrum changes between groups were observed in overall muscles of the
right arm (p=0.04) and left forearm flexors (p=0.05) following one hour of
playing.
Conclusions: Muscle activity and frequency spectrum shifts differ in high
string musicians with and without PRMD, suggesting possible differential
muscle fatigue effects between the groups.
This review gives an overview about the existing research concerning siblings' perspective within the familial experiences of childhood chronic illness. Besides attaining a conception of their world, it was intended to identify the unacknowledged issues concerning siblings' experience. Four databases were systematically searched. The analysis was concentrated on nine literature reviews. As a result, we identified a map of dimensions of experiences—well-elaborated as well as fragmentary. Many of the studies were conducted by a proxy and not from the sole siblings' perspective. Further research should concentrate on the sole siblings' perspective, in order to make siblings' voices audible.
Continuity of care is a concept that is defined as the uninterrupted and coordinated care provided to a patient and that includes an informational dimension which describes the information exchange between the parties involved. In nursing, the nursing summary is the main instrument to ensure informational continuity of care. The aim of this paper is to present an HL7 Clinical Document Architecture based document standard for the eNursing Summary and to discuss the need for harmonizing these results at international level. The eNursing Summary proposed in this paper was developed on the basis of several internationally accepted concepts, primarily the nursing process, the ISO 18104 Reference Terminology Model for Nursing and various data sets. The standardisation process embraced several phases of involving nursing experts for validating its structure and content. It was finally evaluated by a network of 100 healthcare organizations. We argue that the eNursing Summary is a good starting point for standardising nursing discharge and transfer documents on a global level. However, further work is needed to bring together the different national and international strands in standardisation.
In this article, we build on Stigler and Becker’s (1977) “consumption capitaltheory” and propose a novel conceptualization of film quality for the analysisof motion picture franchises. Generally, this theorypredicts that the utilityconsumers derive from a particular goodor service increases with prior con-sumption. We test our theoretical conjectures by drawing on the population ofsequels that were running in the US between 1992 and 2011. The empiricalresults point to the explanatory power of the proposed framework. Filmexecutives may use our findings to improve the profitability of their sequelproductions. From a theoretical point of view, consumption capital theoryallows for a more refined analysis of sequel performance along differentdimensions. Moreover, it may provide a fruitful basis for the analysis of otherserial media content, including books, TV, music, and games.
Objective: To understand the significance of healthy living for users, professionals and managers of the Family Health Strategy (FHS) team.
Methods: Research of a qualitative nature, based on grounded theory. For data collection, interviews were conducted with 25 participants, including users, professionals and managers of a FHS team, during the period between March and December, 2009. Results: The collection and analysis of data was conducted in a systematic and comparative manner, demonstrating that healthy living can be characterized as a selforganizing process, mediated by the action of the FHS team professionals, especially by the community health agent, through creation of bonds of trust and stimulation of interactions and community associations. Conclusion: We concluded that healthy living is a singular phenomenon, complex, interactive, associative, political and social, coupled with the active involvement and participation of the users and by the engagement of effective and socially responsible professionals, managers and established political authorities.
Objective: to understand the meaning of the Adult Intensive Care Unit environment of care,
experienced by professionals working in this unit, managers, patients, families and professional
support services, as well as build a theoretical model about the Adult Intensive Care Unit
environment of care. Method: Grounded Theory, both for the collection and for data analysis.
Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from
three different Adult Intensive Care Units. Results: built up the so-called substantive theory
“Sustaining life in the complex environment of care in the Intensive Care Unit”. It was bounded
by eight categories: “caring and continuously monitoring the patient” and “using appropriate
and differentiated technology” (causal conditions); “Providing a suitable environment” and
“having relatives with concern” (context); “Mediating facilities and difficulties” (intervenienting
conditions); “Organizing the environment and managing the dynamics of the unit” (strategy)
and “finding it difficult to accept and deal with death” (consequences). Conclusion: confirmed
the thesis that “the care environment in the Intensive Care Unit is a living environment, dynamic
and complex that sustains the life of her hospitalized patients”.
Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area.
Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students.
Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator.
Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.
Objective
The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular pain disorders.
Materials and Methods
A total of 29 patients (19 females and 10 males) with myofascial temporomandibular pain disorders, aged 19 to 59 years participated in the study (mean years±SD; 34.69±10.83 y). MMO and the PPT (on the right side) of patients in neutral, retracted, and forward head postures were measured. A 1-way repeated measures analysis of variance followed by 3 pair-wise comparisons were used to determine differences.
Results
Comparisons indicated significant differences in PPT at 3 points within the trigeminal innervated musculature [masseter (M1 and M2) and anterior temporalis (T1)] among the 3 head postures [M1 (F=117.78; P<0.001), M2 (F=129.04; P<0.001), and T1 (F=195.44; P<0.001)]. There were also significant differences in MMO among the 3 head postures (F=208.06; P<0.001). The intrarater reliability on a given day-to-day basis was good with the interclass correlation coefficient ranging from 0.89 to 0.94 and 0.92 to 0.94 for PPT and MMO, respectively, among the different head postures.
Conclusions
The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
The game must go on
(2015)
Objective:
To understand the meaning of entrepreneurial nursing care as inducer of healthy practices in vulnerable communities.
Method:
Grounded theory, whose data collection took place between March and December 2019, from interviews with 19 participants from the central region of Rio Grande do Sul, Brazil and comparative data analysis.
Results:
The phenomenon was delimited: Experiencing small/big transformations in the invisibility of everyday life in promoting healthy practices in vulnerable communities. Conducted by the paradigmatic model, the categories were named based on the components: Condition: Making choices and negotiating non-negotiable exchanges; Action/interaction: Motivating oneself to maintain basic human needs; Consequence: Broadening perspectives and transcending personal and collective boundaries.
Conclusion:
Entrepreneurial nursing care as inducer of healthy practices in vulnerable communities is not reduced to a scientific theory or to the linear and decontextualized apprehension of healthy living, but extends to reach small/big transformations that occur in the invisibility of everyday life.
This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.
Background
Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far.
Objective
The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee.
Methods
MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality).
Conclusions
eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
Background:
Neck pain is one of the most common musculoskeletal pains and among the fourth leading causes of years of life lost due to disability, following back pain, depression, and arthralgia. (1)
In the course of their lives, about 70% of all people will experience a clinically relevant episode of neck pain, (2) so finding a good therapy to treat it is of high interest. Aerobic exercise is associated with pain reduction in patients with different types of MSK pain. Recent studies have shown a positive impact of aerobic exercises on brain function, memory processing, cognition, and motor function. (3, 4)
Therefore, the influence of aerobic exercise on pain modulation seems to be of particular interest for individuals with chronic MSK pain, since brain imaging studies have shown that these patients have structural and functional changes, as well as abnormal brain features in various areas of the brain. The evidence regarding the effectiveness of aerobic exercise for neck pain seems limited and outdated.
Thus, a systematic review evaluating the effects of aerobic exercise in patients with neck pain is needed. Therefore, this review aims to investigate the effectiveness of aerobic exercise interventions when compared to other conservative and non-conservative interventions (e.g., localized exercises, medication, acupuncture, physical agents, manual therapy) to decrease pain intensity in people with neck pain.
Materials and methods:
Electronic literature searches were conducted in a total of six databases such as Medline, Embase, CINAHL, Cochrane Library, Web of Science, and Scopus. The review considered randomised controlled trials (RCTs) including patients over 18 years having musculoskeletal pain in the neck area. The Neck Pain Task Force's classification of pain severity describes four levels of neck pain, with the first three levels considered in this review. (5)These must be clinically diagnosed by a health care provider according to signs and symptoms or based on standardized criteria specific for each disease. Studies involving subjects with any pre-existing conditions, previous surgery, or pain not clearly related to the musculoskeletal system were excluded. No limits were applied in terms of sex, ethnicity, and living country. Data were extracted using a standardized data extraction form.
Methodological quality was determined using the Cochrane Collaboration Risk of Bias Tool (CCRBT) and the strength of the evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and evaluated by two independent reviewers.
Results:
A total of 21585 records were identified and screened independently for eligibility by two reviewers. A total of six unique studies, reported on ten manuscripts met the specified inclusion criteria. Different types of aerobic exercise were used in the studies. Studies included isolated and combined aerobic exercise using interventions such as cycling on an ergometer or walking outdoors at a moderate intensity. Comparison groups were for example strength training or education. The most common outcome was pain assessed with the Visual Analogue Scale (VAS) or the Nordic questionnaire.
The included studies had a high risk of bias and the overall quality of the evidence for this systematic review was considered low. There was high heterogeneity in the included studies regarding interventions applied and study results.
When looking at the effect of aerobic exercise versus control group or other intervention groups measured with VAS, it can be observed, that there was a great heterogeneity between studies results (different magnitudes and directions). Although none of the comparisons showed a statistically significant difference between aerobic exercise and control (MD 6.24 mm, 95% CI [-11.21; 23.96]) or active intervention groups (MD -9.52 mm, 95% CI [-18.48; -0.56]) on pain intensity; it seems that aerobic exercise is slightly better than a control group, and equally effective as other active treatments such as strength exercise or education.
In addition, when combined with other therapeutic modalities, aerobic exercise, could potentially help to reduce pain intensity (MD 7.71 mm, 95% CI [1.07; 14.35]). Especially in the long term, the combination of strength and aerobic exercise showed promising results. Statistically significant differences in favour of aerobic exercise for pre vs. three months follow up (MD 11.20 mm, 95% CI [2.85;19.55]) and pre vs. six moths follow up (MD 15.10 mm, 95% CI [6.99; 23.21]) were found.
Conclusions:
Although there is currently limited evidence on the effectiveness of aerobic exercise in individuals with chronic neck pain, aerobic exercise was found to not only reduce pain intensity, but also to improve disability as well as physical and emotional functioning. However, as the evidence is limited, low quality, and heterogeneous, further research is needed in this area to obtain more accurate results.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
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