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Managerscheitern
(2017)
Im Studium kommen Sie am Bürgerlichen Recht kaum vorbei und das zu Recht: Es ist eben nunmal wichtig. Oliver Tillmann erklärt Ihnen die Systematik des BGB und was Sie zum Allgemeinen Teil wissen sollten. Hier erfahren Sie, das Wichtigste zu Willenserklärungen, Verträge, Stellvertretung, Rechts- und Geschäftsfähigkeit. Außerdem führt er Sie in das Schuldrecht und das Sachenrecht ein. Kursorisch streift er gegen Ende des Buches auch noch das Familien- und Erbrecht. Zahlreiche Übungsaufgaben mit Lösungen helfen Ihnen, Ihr Wissen zu testen und zu festigen.
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.
Characterisation of pain in people with hereditary neuropathy with liability to pressure palsy
(2017)
Hereditary neuropathy with liability to pressure palsy (HNPP) has historically been considered a pain-free condition, though some people with HNPP also complain of pain. This study characterised persistent pain in people with HNPP. Participants provided cross-sectional demographic data, information on the presence of neurological and persistent pain symptoms, and the degree to which these interfered with daily life. The painDETECT and Central Sensitization Inventory questionnaires were used to indicate potential neuropathic, central sensitisation and musculoskeletal (nociceptive) pain mechanisms. Additionally, participants were asked if they thought that pain was related to/part of HNPP. 32/43 (74%) subjects with HNPP had persistent pain and experience this pain in the last week. Of those with pain, 24 (75%) were likely to have neuropathic pain and 27 (84%) were likely to have central sensitisation. All 32 participants felt that their pain could be related to/part of their HNPP. Significant negative impact of the pain was common. Pain characterisation identified neuropathic pain and/or central sensitisation as common, potential underlying processes. Pain may plausibly be directly related to the underlying pathophysiology of HNPP. Further consideration of including pain as a primary symptom of HNPP is warranted.
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.
Der MDK-Prüfprozess: Effizienzsteigerungen durch optimal strukturierte, digitale Patientenakten
(2017)
Der zunehmende Digitalisierungsgrad in deutschen Krankenhäusern verspricht unter anderem Prozesseffizienzen, deren Ausmaß bisher jedoch noch nicht ausreichend untersucht wurde. Vor dem Hintergrund der Erlössicherung eines Krankenhauses spielen der MDK-Prüfprozess und dessen Vorbereitung eine wichtige Rolle. Es stellt sich daher die Frage, ob und in welchem Ausmaß digitale und optimal strukturierte Patientenakten die Bearbeitung von MDK-Anfragen unterstützen und beschleunigen können.
Durch eine Gegenüberstellung der Durchführung des MDK-Prüfprozesses mit papierbasierten sowie mit digitalisierten Patientenakten sollen mögliche Effizienzsteigerungen identifiziert werden. Des Weiteren wird untersucht, wie Patientenakten optimal strukturiert werden können: durch eine manuelle gegenüber einer automatisierten Sortierung von Dokumenten in ein vom Krankenhaus vorgegebenes Register.
Der Big-Data-Bluff
(2017)
Objective
Gross mandibular position and masticatory muscle activity have been shown to influence cervical muscles electromyographic activity. The purpose of this study was to investigate the influence of three different mandible positions including conscious occlusion, tongue tip against the anterior hard palate (Palate tongue position) and natural resting position (Rest), on sagittal plane cervical spine range of motion (ROM) as well as the flexion-rotation test (FRT) in asymptomatic subjects.
Materials and methods
An experienced single blinded examiner evaluated ROM using an Iphone in 22 subjects (7 females; mean age of 29.91years, SD 5.44).
Results
Intra-rater reliability for range recorded was good for the FRT with ICC (intraclass correlation) 0.95 (95% CI: 0.88–0.98) and good for sagittal plane cervical ROM with ICC 0.90 (95% CI: 0.77–0.96). A repeated measures ANOVA determined that mean ROM recorded during the FRT differed significantly between assessment points (F(1.99, 41.83) = 19.88, P < 0.001). Bonferroni Post hoc tests revealed that both conscious Occlusion and Palate tongue position elicited a significant large reduction in ROM recorded during the FRT from baseline (p < 0.01). Despite this, one activation strategy did not influence ROM more than the other. An additional repeated measures ANOVA determined that mean sagittal cervical ROM did not significantly vary between assessment points (F(2, 42) = 8.18, P = 0.08).
Conclusion
This current study provided further evidence for the influence of the temporomandibular region on upper cervical ROM. Results suggest that clinicians should focus on the natural mandible rest position when evaluating upper cervical mobility.
Objective:
To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder.
Design:
Double-blinded, randomized, experimental study.
Setting:
Outpatient clinic.
Subjects:
We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint.
Interventions:
The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day.
Main measures:
Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy.
Results:
A total of 66 patients were randomized into two groups: The activity-oriented group (n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group (n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up (p < 0.05).
Conclusions:
Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.
Hintergrund
Ziel dieser Studie ist es, die Auswirkungen einer Kinesiophobie auf die Emotions- sowie Lateralitätserkennung zu untersuchen.
Material und Methoden
67 Probanden mit chronischen muskuloskeletalen Schmerzen wurden untersucht. Hierbei erzielten 24 Probanden einen Wert von >37 auf der Tampa-Skala für Kinesiophobie und wurden in die Querschnittstudie eingeschlossen. Die Fähigkeit zur Erkennung mimisch codierter Basisemotionen wurde mittels des Facially-Expressed-Emotion-Labeling(FEEL)-Tests und die Lateralitätserkennung anhand eines speziellen Face-Mirroring-Assessment-and-Treatment-Programms ermittelt. Die Toronto-Alexithymie-Skala (TAS) 26 diente zur Erfassung einer Alexithymie.
Ergebnisse
Der FEEL-Score der Probanden mit Kinesiophobie war signifikant niedriger (p = 0,019). Die Basisemotionen Angst (p = 0,026), Ärger (p = 0,027) und Überraschung (p = 0,014) verdeutlichten einen signifikanten Unterschied zwischen den Ergebnissen der Querschnittstudie und gesunden Probanden. Der Alexithymiefragebogen TAS-26 zeigte lediglich in der TAS 1 (Schwierigkeiten bei der Identifikation von Gefühlen; p = 0,008) einen signifikanten Unterschied zwischen Probanden mit Kinesiophobie.
Schlussfolgerung
Die Ergebnisse zeigen, dass kinesiophobische Patienten Veränderungen in der Emotions- und Lateralitätserkennung sowie alexithyme Merkmale aufweisen.