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Background
A wide range of physical tests have been published for use in the assessment of musculoskeletal dysfunction in patients with headache. Which tests are used depends on a physiotherapist's clinical and scientific background as there is little guidance on the most clinically useful tests.
Objectives
To identify which physical examination tests international experts in physiotherapy consider the most clinically useful for the assessment of patients with headache.
Design/methods
Delphi survey with pre-specified procedures based on a systematic search of the literature for physical examination tests proposed for the assessment of musculoskeletal dysfunction in patients with headache.
Results
Seventeen experts completed all three rounds of the survey. Fifteen tests were included in round one with eleven additional tests suggested by the experts. Finally eleven physical examination tests were considered clinically useful: manual joint palpation, the cranio-cervical flexion test, the cervical flexion-rotation test, active range of cervical movement, head forward position, trigger point palpation, muscle tests of the shoulder girdle, passive physiological intervertebral movements, reproduction and resolution of headache symptoms, screening of the thoracic spine, and combined movement tests.
Conclusions
Eleven tests are suggested as a minimum standard for the physical examination of musculoskeletal dysfunctions in patients with headache.
Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning.
Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking.
Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist.
Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons.
Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
Länderübergreifendes Change Management hat in den letzten Jahren an Bedeutung gewonnen. Aber lassen sich "westlich" geprägte Vorgehensweisen im Unternehmenswandel als Best-Practice-Ansätze global nutzen oder sind kulturell bedingte Anpassungen notwendig? In einer quantitativen Studie wurden die Bewertungen verschiedener Veränderungsszenarien durch deutsche und südkoreanische Teilnehmer erhoben.
Das Ziel des Artikels ist es, ein deskriptives Modell der internen Veränderungskommunikation zu entwickeln, welches auf literarischen Klassikern der Kommunikationswissenschaft, Unternehmenspsychologie, Soziologie sowie der Managementlehre basiert. Die Autoren des Artikels vertreten mit dem Modell die Meinung, dass nur durch den Einbezug des dialogorientierten Ansatzes eine erfolgversprechende Veränderungskommunikation gelingen kann. Der Dialog zwischen direkten und indirekten Beteiligten, also zwischen Veränderungsstrategen und der Unternehmenskommunikation auf der einen sowie der restlichen Mitarbeiter auf der anderen Seite, muss während der gesamten Veränderung geführt werden und das gestiegene Informationsbedürfnis aller Beteiligten befriedigen können. An oberster Stelle steht hierbei die kommunikative Vermittlung von Sinn und Erklärungen für die Veränderung. Hierfür bedarf es zwingend der Einteilung der indirekt Beteiligten in die Untergruppen: Vorantreiber, Unterstützer, Skeptiker und Gegenspieler, die allesamt in die Veränderungskommunikation einbezogen werden sollten. Der Artikel versteht Kommunikation als sozial konstruierten Prozess der Sinnesdeutung. Er richtet sich an forschende Akademiker und Mitarbeiter in Unternehmen, die zur Gruppe der „Direkt Beteiligten“ gehören und ein Verständnis dafür entwickeln möchten, wie eine effektive Kommunikation im Wandel erfolgen kann.
Background:
One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.
Objective:
The aim of the present study was to identify predictors of dropout from this Web program.
Methods:
A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants’ age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method.
Results:
The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout.
Conclusions:
Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
The central objective of early prevention in Germany is an improved cooperation between professional groups of the health services and child and youth welfare in interprofessional networks. This objective derives from the realisation that proper care for families with infants can only be achieved if the various groups act in close integration. The ‘Federal Initiative early prevention’ explicitly calls for freelance midwives to be integrated in this context. However, only a few scientific findings on midwives’ cooperation in networks of early prevention have been published to date. This integrative review aims to identify the central themes of interprofessional cooperation of midwives in out-of-hospital obstetrical care from national and international research literature. A systematic search of five research databases for publications between 2005 and 2015 was performed, complemented by a manual search. 25 studies were identified describing various contexts where midwives in out-of-hospital obstetrical care cooperate with other professional groups. Four key themes were analysed: contexts of cooperation, benefits of cooperation, facilitating and restrictive factors of cooperation, and competencies of cooperation. The studies show that there is only limited research coverage of the midwives’ perspective regarding interprofessional cooperation. The existing studies examine the cooperation of midwives primarily with health care professionals, and secondarily with professionals in the social services. In order to expand knowledge on the cooperation of freelance midwives in the networks of early prevention, future research should focus on the perspective of midwives regarding cooperation with other professional groups, both in the health care sector and in the field of social services.
In der inklusiven Grundschule arbeiten zunehmend verschiedene Professionen, wie bspw. Lehrer*innen, Sonderpädagog*innen oder Schulsozialarbeiter*innen, interprofessionell zusammen. Dieser Wandel in schulischen Arbeitskontexten geht mit veränderten Professionalisierungsanforderungen für die Lehr- und Fachkräfte einher (vgl. Kleina & Tan, 2019, S. 63). Die Praxis interprofessioneller Kooperation in der inklusiven Grundschule ist dabei bisher nur in Teilfragen erforscht (vgl. Moldenhauer, 2019), kaum aber mit Blick auf die Erfahrungen und Erwartungen der pädagogischen Lehr- und Fachkräfte selbst. Hierzu werden Ergebnisse einer quantitativen Bedarfserhebung (N=271), welche im Rahmen des vom BMBF geförderten Forschungs- und Entwicklungsprojektes InproKiG bei Lehrkräften und pädagogischen Fachkräften von Schulteams in Niedersachsen und Hessen durchgeführt wurde, vorgestellt. Die Ergebnisse geben Aufschluss über die Entwicklung und Gestaltung von Qualifizierungsmaßnahmen in diesem Bereich. Neben der Qualifizierung der bereits tätigen Lehr- und Fachkräfte, kann das InproKiG-Manual auch in der Lehrer*innenausbildung eingesetzt werden.
The political geography of central government debt has hardly been investigated. We propose a method for calculating implicit interregional transfers stemming from central government debt.
We apply this method to Belgium over the 1970-2016 period. The share of poorer Francophone Belgium in debt-financed central government spending was persistently larger than its share in central government revenue used to pay the resulting interest bills. The opposite holds for richer Flanders. Also, a primary deficit in one particular year leads to an interest bill in each of the following years as long as debt caused by that primary deficit is not repaid. All the above caused debt-related transfers from Flanders to Francophone Belgium of over 7% of Flemish GDP during many years.
Interregional interest transfers may also be large in the many other democracies suffering from both high central government debt and considerable geographic income disparities.
The size of these transfers may in turn explain the size and persistence of central government deficits. This is also because poorer, less densely populated regions such as Francophone Belgium tend to be overrepresented within central governments. This strengthens their ability to cause deficits.
We recommend more fiscal decentralisation or at least smaller central government deficits.
This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
Die Anforderungen an zukünftige Teilnehmende eines Arbeitsmarktes verändern sich. Das von Frithjof Bergmann begründete Prinzip der Neuen Arbeit (Bergmann, 2004) ist aktuell Gegenstand zahlreicher Diskussionen und Debatten über aktuelle und zukünftige Arbeitswelten. Die sich daraus ergebenden Kompetenzanforderungen passen mit der Lehre in Hochschulen wenig zusammen. Zunehmend werden agile Lernszenarien diskutiert.
Das Inverted Classroom Modell (ICM) erfreut sich seit einigen Jahren großer Beliebtheit in der Hochschullehre. Aus Studierendensicht ist die Teilnahme an einer ICM-Veranstaltung aber eine Herausforderung. Für ein erfolgreiches Lernen sind insbesondere personale Kompetenzen wie Selbstmotivation, Durchhaltevermögen und Selbstregulationskompetenz erforderlich (Pöpel & Morisse, 2019). Um diesem Umstand entgegenzuwirken, wurde vom Autor ICM mit Ideen aus Scrum für eine Informatik-Lehrveranstaltung kombiniert (siehe auch (Morisse & Heidemann, 2021)). Die Wirkung von Scrum kann sich nur entfalten, wenn die Arbeit in einzelne Sprints aufgeteilt wird und bei der Bearbeitung der Sprints auch die eigene Zusammenarbeit im Rahmen einer Retrospektive kritisch reflektiert wird. Zu diesem Zweck wird der gesamte Inhalt der Lehrveranstaltung in eine Anzahl von thematischen Blöcken aufgeteilt, die als Lehr- und Lerninhalte für die Lern-Sprints der Scrum-Umsetzung werden. Für jeden Themenblock müssen die theoretischen Inhalte erarbeitet sowie eine eigenständige Zusammenfassung formuliert werden. Ergänzend dazu wurde ein Software-Produkt definiert, in dessen Rahmen die theoretischen Inhalte einfließen konnten.
Die Durchführung eines Reviews und einer Retrospektive schließen bei Scrum einen Sprint ab. Genau dies lässt sich auch im Hochschulkontext sehr gut als Feedback-Instrument durchführen. Das Review bestand in der Inspektion der entwickelten Software. Mit der Retrospektive wird die eigene Zusammenarbeit im Team kritisch reflektiert. Ein besonderes Augenmerk verdient der kommunikative Stil zwischen Lehrenden und Studierenden. Bei einem Veranstaltungskonzept, welches getragen wird von Interaktion und Diskussion, kommt einer empathischen und wertschätzenden Kommunikation eine besondere Bedeutung zu. Das dies in der vorgestellten Veranstaltung scheinbar gelungen ist, zeigt das Zitat eines der teilnehmenden Studierenden „Ich freue mich immer auf die Review-Termine“. Zur Erinnerung: Das Review ist der Termin zur Vorstellung des erreichten Ergebnisses, also eher ein Prüfungs-Setting, bei dem Studierende ihre Arbeit präsentieren. Weitere positive Resonanzmerkmale durch die Studierenden waren die hoffnungsvollen Fragen, ob denn die Veranstaltungen im kommenden Semester auch nach ICMScrum organisiert sind.
Background: The majority of health IT adoption research focuses on the later stages of the IT adoption process: namely on the implementation phase. The first stage, however, which is defined as the knowledge-stage, remains widely unobserved. Following Rogers’ Diffusion of Innovation Theory (DOI) this paper presents a research framework to examine the possible lack of shared IT awareness-knowledge, i.e. an information gradient, of two crucial stakeholders, the Chief Information Officer (CIO) and the Director of Nursing (DoN). This study shall answer the following research questions: (1.) Does this gradient exist? (2.) Which direction does it have? (3.) Are certain health IT (HIT) attributes associated with a potential gradient? (4.) Which determinants of diffusion go along with this gradient?
Method: Results of two surveys that focused on the topic “IT support of clinical workflows” from the viewpoint of CIOs and DoNs with corresponding datasets from 75 hospitals were used in a secondary data analysis. The gradient was operationalised by measuring the disagreement of CIOs and DoNs on the availability and implementation status of 29 IT functions. HIT attributes tested were relevance and market penetration of the IT functions, determinants of diffusion were inter-professional leadership and IT service density.
Results: The analysis revealed a significant disagreement on the availability of 9 out of 29 HIT functions. In 23 HIT functions, the CIOs reported a higher implementation status than the DoNs, which pointed to a trend for a unidirectional gradient. The disagreement was significantly lower when the relevance of the IT function was high. Both determinants of diffusion correlated significantly negative with the degree of disagreement.
Conclusion: This is the first study to empirically examine shared awareness-knowledge of two IT-stakeholders that are crucial for triggering IT adoption on the frontline level in hospitals. It could be shown that a gradient and thus a lack of shared awareness-knowledge existed and was associated with certain factors. In conclusion, hospitals should implement improved cooperation between IT staff and clinicians and IT service density when establishing the prerequisites for successful IT adoption processes.
While the topic of artificial intelligence (AI) in multinational enterprises has been receiving attention for some time, small and medium enterprises (SMEs) have recently begun to recognize the potential of this new technology. However, the focus of previous research and AI applications has therefore mostly been on large enterprises. This poses a particular issue, as the vastly different starting conditions of various company sizes, such as data availability, play a central role in the context of AI. For this reason, our systematic literature review, based on the PRISMA protocol, consolidates the state of the art of AI with an explicit focus on SMEs and highlights the perceived challenges regarding implementation in this company size. This allowed us to identify various business activities that have been scarcely considered. Simultaneously, it led to the discovery of a total of 27 different challenges perceived by SMEs in the adoption of AI. This enables SMEs to apply the identified challenges to their own AI projects in advance, preventing the oversight of any potential obstacles or risks. The lack of knowledge, costs, and inadequate infrastructure are perceived as the most common barriers to implementation, addressing social, economic, and technological aspects in particular. This illustrates the need for a wide range of support for SMEs regarding an AI introduction, which covers various subject areas, like funding and advice, and differentiates between company sizes.