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Attitudes Concerning Postmortem Organ Donation : A Multicenter Survey in Various German Cohorts
(2015)
BACKGROUND
The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts.
MATERIAL AND METHODS
Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family.
RESULTS
Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants’ attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information.
CONCLUSIONS
Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.
Clinically Significant Differences in Acute Pain Measured on Self-report Pain Scales in Children
(2015)
Objectives
The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale–Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics.
Methods
This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS−R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with “a little less” and “much less” pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic–based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain.
Results
A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain.
Conclusions
The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
Background: Clinical handovers at changes of shifts are typical scenarios of time restricted and information intensive communication, which are highly cognitively demanding. The currently available applications supporting handovers typically present complex information in a textual checklist-like manner. This presentation style has been criticised for not meeting the specific user requirements.
Objectives: We, therefore, aimed at developing a concept for visualising the overview of a clinical case that serves as an alternative way to checklist-like presentations in clinical handovers. We also aimed at implementing this concept in a handoverEHR in order to support the pre-handover phase, the actual handover, and the post-handover phase as well as at evaluating its usability and attractiveness.
Results: We developed and implemented a concept that draws on Tolman's pioneering work on cognitive maps that we designed in accordance with Gestalt principles. These maps provide a pictorial overview of a clinical case. The application to build, manipulate, and store the cognitive maps was integrated into an openEHR based handover record that extends conventional records with handover specific information. Usability (n = 28) and attractiveness (n = 26) testing with experienced clinicians resulted in good ratings for suitability for the task as well as for attractiveness and pragmatism.
Conclusion: We propose cognitive maps to represent and visualise the clinical case in situations where there is limited time to present complex information.
In this paper we want to review and discuss research on the effects of occupational health management activities and services on different outcomes like employee health and well-being or absenteeism and other economic outcomes. In part I we outline goals and functions of occupational health management (OHM), then characterize typical occupational health promotion interventions and describe principles for implementing and organizing OHM. Part II focuses on different OHM activities and services such as creating healthy and safe workplace, reducing work-family conflicts, providing counselling via employee assistance programs and implementing health circles or stress management interventions. We will also discuss intervention design and sample studies as well as meta-analytic data relating to the effectiveness of these interventions. Finally, part III is about the economic impact of OHM. Findings from a management evaluation approach for OHM will be discussed. Then we will concentrate especially on data linking health promotion interventions to absenteeism and financial outcomes expressed as cost savings or cost-benefit ratios. The concluding part summarizes key findings of this paper.
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.
Aims:
To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.
Methods:
A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the ‘gold standard’ for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.
Results:
A total of 43 (49%) children (aged 6–18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.
Conclusion:
The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
A patient presenting with local pain and limitation of movement in the temporomandibular region following surgery of the left temporomandibular joint (TMJ) is described. Manual techniques like distraction of the TMJ combined with motor control exercises to restore TMJ function were not sufficient to relieve the patient's symptoms and her orofacial functions. However, during manual assessment and treatment of cranial nervous tissue, in this case the auriculotemporal nerve and its interface, pain was relieved and orofacial functions improved.
Although national eHealth strategies have existed now for more than a decade in many countries, they have been implemented with varying success. In Germany, the eHealth strategy so far has resulted in a roll out of electronic health cards for all citizens in the statutory health insurance, but in no clinically meaningful IT-applications. The aim of this study was to test the technical and organisation feasibility, usability, and utility of an eDischarge application embedded into a laboratory Health Telematics Infrastructure (TI). The tests embraced the exchange of eDischarge summaries based on the multiprofessional HL7 eNursing Summary standard between a municipal hospital and a nursing home. All in all, 36 transmissions of electronic discharge documents took place. They demonstrated the technical-organisation feasibility and resulted in moderate usability ratings. A comparison between eDischarge and paper-based summaries hinted at higher ratings of utility and information completeness for eDischarges. Despite problems with handling the electronic health card, the proof-of-concept for the first clinically meaningful IT-application in the German Health TI could be regarded as successful.
The study at hand focuses the interdependencies between stress incidents and strategies of stress-coping in relation with well-being in helping professions. Furthermore, the scarce areas and the proband’s strategies of health behavior, comparing helping and other vocational groups, are investigated. The sample consist of teachers, bank employees, employees of marketing agencies, employees coming from the machine construction industry, as well as nurses, psychotherapists and physicians. The results show that everyday annoyances and problem-oriented stress-coping indeed affect well-being.
Usability is a core construct of website evaluation and inherently defined as interactive. Yet, when analysing first impressions of websites, expected usability, i.e., before use, is of interest. Here we investigate to what extend ratings of expected usability are related to (a) experienced usability, i.e., ratings after use, and (b) objective usability measures, i.e., task performance. Furthermore, we try to elucidate how ratings of expected usability are correlated to aesthetic judgments. In an experiment, 57 participants submitted expected usability ratings after the presentation of website screenshots in three viewing-time conditions (50, 500, and 10,000 ms) and after an interactive task (experienced usability). Additionally, objective usability measures (task completion and duration) and subjective aesthetics evaluations were recorded for each website. The results at both the group and individual level show that expected usability ratings are not significantly related either to experienced usability or objective usability measures. Instead, they are highly correlated with aesthetics ratings. Taken together, our results highlight the need for interaction in empirical website usability testing, even when exploring very early usability impressions. In our study, user ratings of expected usability were no valid proxy neither for objective usability nor for experienced website usability.
Gender disparities in German home-care arrangements
An ageing population correlates with rising needs for
long-term care (LTC). Support programmes should con-
sider the specific needs of the various subgroups of care
dependents and family caregivers. The objective of this
study was to analyse the gender-specific disparities in
home-care arrangements in Germany, and for this pur-
pose, survey and insurance claims data were used. A sur-
vey of 2545 insured care recipients with high-level care
needs was conducted in 2012 with the Barmer GEK, a
major German statutory healthcare insurance. Insurance
claims data were provided for a follow-up, focussing on
the group aged 60 years and older. For statistical compar-
ison, chi-squared test and t-tests were used, and a p-
value < 0.05 was considered statistically significant. Most
care recipients are female, and they are on average
2 years older than males. Men receive family care mostly
from their wives, whereas widows frequently live alone
and receive care from daughters, sons, other relatives,
neighbours and friends, as well as from professional
nursing services. Furthermore, women more often antici-
pate the need for (further) professional assistance and
move in with a relative or to an assisted living facility or
a nursing home in good time. The desired rate for reloca-
tion to a nursing home was higher than the anticipated,
and during the 6-month follow-up, the actual rate of
relocations was in between both. In summary, the caring
situation of men and women is different. Care-receiving
men are most often cared for by their wives. Widowed
women need a social network and their children in order
to remain in their own home. To provide better home-
care arrangements for women in this situation, the fam-
ily and social networks need a stronger focus in politics
and research. To stabilise the home-care situation of men
with high-level care needs, their wives need more
support.
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.
Objectives: to identify the errors in daily intensive nursing care and analyze them according to the theory of human error. Method: quantitative, descriptive and exploratory study, undertaken at the Intensive Care Center of a hospital in the Brazilian Sentinel Hospital Network. The participants were 36 professionals from the nursing team. The data were collected through semistructured interviews, observation and lexical analysis in the software ALCESTE®. Results: human error in nursing care can be related to the approach of the system, through active faults and latent conditions. The active faults are represented by the errors in medication administration and not raising the bedside rails. The latent conditions can be related to the communication difficulties in the multiprofessional team, lack of standards and institutional routines and absence of material resources. Conclusion: the errors identified interfere in nursing care and the clients’ recovery and can cause damage. Nevertheless, they are treated as common events inherent in daily practice. The need to acknowledge these events is emphasized, stimulating the safety culture at the institution.
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.
The concept of "quality" is quite complex and challenging. In higher education, quality might be defined very differently by the various stakeholders: the students and graduates might see quality in terms of making sure they get well-paid jobs, the academics might define quality from the perspective of being able to enter in scientific debates, the ministries might define quality in terms of the efficient use of resources for reaching certain goals. But even when such issues of clarification of meanings are solved, what are the tools which work. And what does quality mean with respect to internationalisation? A number of papers in this book address quality management from various angles, and provide food for thought for those who seek for good answers.
This book is the third in a series, and assembles contributions from authors who participated in the International Deans Course, a programme for leaders in higher education from East and West Africa and Southeast Asia respectively.
The following article deals with equivalence as a specific quality criterion concerning cross cultural research in psychology and provides an overview for this topic. The comparability of constructs as well as of data is analyzed. For this, the different levels of equivalence are regarded, e.g., translation equivalence and others. Classical as well as modern methods for the testing and guarantee of equivalence are analyzed. Critical approaches and methodical problems of cross cultural research are described.