610 Medizin, Gesundheit
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Institute
Innovationen sind die stärksten Gestaltungsfaktoren für eine neue vielversprechende Zukunft, da sie die wichtigsten Treiber für Wachstum und Ertrag in unserer Wirtschaft sind. Die aktuelle Zeitenwende zeigt uns sehr deutlich, dass wir ohne Innovationen bzw. Veränderungen und Anpassungen kaum noch wettbewerbsfähig bleiben, sowohl als Nation bzw. als Gesellschaft und insbesondere als Unternehmen.
Die hohe Dynamik und Komplexität der wirtschaftlichen und sozialen Prozesse setzt neue Maßstäbe an die Innovationsstrategien von Institutionen und Unternehmen.
Neue Technologien, neue Märkte, neues Kundenverhalten und der stetige Wandel sowohl in der Arbeitswelt als auch in unserem gesellschaftlichen Umfeld, wie z.B. die Digitalisierung, zeigen uns, dass allein eine Produktinnovation als solche heute nicht mehr ausreicht. Unter den genannten Randbedingungen müssen Innovationen auch in der Gestaltung von Geschäftsprozessen und Realisierung der "Work-Life-Balance" neu erdacht bzw. überprüft werden.
Der Vorsprung innovativer Produkte im viralen Wettbewerb ist oft nur kurz. Ein ganzheitliches Innovationsmanagement hat alle Bereiche des Unternehmens einzubeziehen und führt zu neuen Geschäftsmodellen, die etablierte Geschäftspraktiken verdrängen, ebenso tauchen durch neue Technologien in immer stärkerem Maße neue Anbieter auf, die die Spielregeln in den Märkten verändern.
Der 1. Deutsche Innovations-Kongress will Impulse setzen, Best-Practice-Modelle als Vorbilder anbieten und im Austausch zwischen den Referent*innen und den Teilnehmer*innen neue Wege bzw. Perspektiven eröffnen.
Wir freuen uns auf alle Teilnehmer*innen und den Erfahrungsaustausch, um aktuelle und nachhaltige Innovations-Impulse zu setzen und neue Wege erfolgversprechende Wege zu beschreiben, womit die bereits fruchtbaren Kooperationen zwischen Wirtschaft und Wissenschaft im Großraum Osnabrück noch weiter belebt werden soll.
Aktuell tragen auch 8 Studierendengruppen des Masterstudiengangs "Entwicklung und Produktion" der Hochschule Osnabrück in der Fakultät I u. I im Rahmen des Moduls "Innovationsmanagement" in Kooperation mit Unternehmen aus der Region durch die Entwicklung neuer innovativer Produkte zum Erfolg des Kongresses bei. Die Zwischenergebnisse dazu werden in einer Poster-Ausstellung präsentiert. Die Innovationsprojekte werden unter der Leitung von Prof. Dr. Jens Schäfer durchgeführt.
In Deutschland werden 80% der auf Pflege angewiesenen Menschen im häuslichen Umfeld versorgt, 56 % davon aufgrund sozialer Beziehungen ausschließlich von informell pflegenden Personen. Die Anzahl häuslicher Pflegearrangements steigt seit Jahren kontinuierlich bei bereits erreichter Kapazitätsgrenze existierender ambulanter Dienste. Um einen Beitrag zum wissenschaftlichen Verständnis pflegerischer Versorgung im häuslichen Setting zu leisten, wurden insgesamt 18 narrative Interviews zu Wunsch und Wirklichkeit häuslicher Pflege mit pflegebedürftigen und pflegenden Personen sowie zwei Expert*innen geführt und nach den Prinzipien der Grounded Theory ausgewertet. Die entwickelte Akzeptanztheorie bietet einen grundsätzlichen Erklärungsansatz informeller Pflege und verweist auf die dringliche und unabdingbar notwendige Weiterentwicklung ambulanter Versorgungsstrukturen, sollen Pflegearrangements in großer Anzahl weiterhin Bestand haben.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
Background
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
Um die Ausgaben der gesetzlichen Krankenversicherung in Deutschland zu senken, wurde mit dem GKV-Finanzstabilisierungsgesetz neben anderen Maßnahmen die Aufhebung der Neupatientenregelung zum Jahresbeginn 2023 durchgesetzt. In politischen Kreisen wurde die Aufhebung der Regelung unter Verweis auf einen erschwerten Patientenzugang im ambulanten Sektor teils deutlich kritisiert. Um zu überprüfen, wie es um die Bereitschaft zur Aufnahme von Neupatienten nach Aufhebung der Neupatientenregelung bestellt ist, wurden im Rahmen einer randomisierten empirischen Feldstudie im Zeitraum von März bis April 2023 insgesamt 180 niedersächsische Hausärzte angerufen. Dabei gab sich der Studienautor als zugezogener Neupatient aus, der auf der Suche nach einem neuen Hausarzt sei. Da im Vorfeld eine schlechte telefonische Erreichbarkeit erwartet worden war, wurden jeder Arztpraxis bis zu drei Anrufversuche gewährt. Es zeigte sich, dass gut zwei Drittel der erreichten Praxen zur Aufnahme eines Neupatienten bereit sind. Außerdem konnte festgestellt werden, dass ein hoher regionaler Versorgungsgrad mit einer schlechten telefonischen Erreichbarkeit der Arztpraxen in Verbindung steht. Bezüglich der Organisationsformen und der Anzahl an Ärzten je Praxis konnten keine signifikanten Korrelationen festgestellt werden. Montags war die telefonische Erreichbarkeit der Praxen deutlich geringer als mittwochs und freitags. Die vorliegende Bachelorarbeit beschreibt die für die Studiendurchführung relevanten Grundlagen der hausärztlichen Versorgung in Deutschland, begründet die verwendete Methodik und diskutiert die Studienergebnisse.
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. The purpose of this workshop is to show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
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.
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
Körperhaltung und Muskelspannung beeinflussen den Klang der Stimme. Aber gibt es auch einen Zusammenhang zwischen der motorischen Kontrolle der Nacken-, Gesichts- und Kieferregion und der Stimme? Die Pilotstudie mit 12 Sängerinnen ging dieser Frage nach und zeigt: Es ist sinnvoll, die motorische Kontrolle zu testen, wenn Patient*innen mit Stimmproblemen zur Physiotherapie kommen.
Purpose
Sedentary behaviour (SED) and low level of physical activity (PA) might be associated with the development or worsening of pain. Still, studies assessing physical behaviours by accelerometry in individuals with orofacial pain are limited. This study aims to assess whether women with temporomandibular disorders (TMD) present different patterns of physical behaviours in days with (DWP) or without pain (DWoP).
Methods
Twenty-nine out of forty-four women (mean age 29.21 sd 7.96) were diagnosed with TMD and monitored over seven days using a thigh-worn accelerometer. DWP was determined when subjects presented pain in one of the craniocervical regions (head, jaw and neck) with intensity of at least 3 in the numerical rating scale. To be considered a DWoP, the individual presented less than 3 points in the three regions. Daily time-use compositions were described in terms of SED in short (<30 min) and long (≥30 min) bouts, light PA (LPA), moderate-to-vigorous PA (MVPA), and time-in-bed. Isometric log-ratios (ilr) were calculated to express the ratio of time-in-bed to time spent awake, SED relative to LPA and MVPA, SED in short relative to long bouts, and LPA relative to MVPA. Differences between DWP and DWoP were examined using MANOVA, followed by univariate post-hoc tests of pairwise differences.
Results
During DWP, women with TMD spent more time in SED in short (239 min) and long bouts (419 min), less time in LPA (245 min), MVPA (68 min), and in bed (468 min) compared with DWoP (235, 378, 263, 70 and 493 min, respectively). The MANOVA showed that all sets of ilrs did not differ statistically (ηp2 = 0.19, p = 0.25). Still, the post-hoc tests showed a trend that time spent SED relative to LPA and MVPA was larger in DWP than in DWoP (Cohen’s d = 0.36, p = 0.05).
Conclusions
Women with TMD did not show different patterns of physical behaviours in DWP or DWoP. However, there is a trend of more sedentary behaviour and less physical activity in DWP compared to DWoP. Future studies should consider other pain intensity cut-offs, isolated pain locations, and larger sample sizes to confirm these results.
The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students’ evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.
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