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Objectives
Quality of care largely depends on successful teamwork, which in turn needs effective communication between health professionals. To communicate successfully in a team, health professionals need to strive for the same goals. However, it has been left largely unaddressed which goals professionals consider to be important. In this study, we aim to identify these goals and analyse whether differences between (1) personal and organisational goals, (2) different professions and (3) hierarchical levels exist in neonatal intensive care units (NICUs).
Design
Goals were identified based on a literature review and a workshop with health professionals and tested in a pilot study. Subsequently, in the main study, a cross-sectional employee survey was undertaken.
Setting and participants
1489 nurses and 537 physicians from 66 German NICUs completed the
questionnaire regarding personal and organisational goal importance between May and July 2013. Answers were given based on a 7-point Likert scale varying between none and exceptionally high importance.
Results
Results show that the goals can be subdivided into three main goal dimensions: patients, parents and staff. Furthermore, our results reveal significant differences between different professions and different hierarchical level: physicians rated patient goals with a
mean (95% CI) importance of 6.37 (3.32 to 6.43), which is significantly higher than nurses with a mean (95% CI) importance of 6.15 (6.12 to 6.19) (p<0.01). Otherwise, nurses classified parental goals as more important (p<0.01). Furthermore, professionals in leading positions rate patient goals significantly higher than professionals that are not in leading positions (6.36 (3.28 to 6.44) vs 6.19 (6.15 to 6.22), p<0.01).
Conclusions
Different employee goals need to be considered in decision-making
processes to enhance employee motivation and the effectiveness of teamwork.
Since child maltreatment has highly negative effects on child adjustment, early identification of at-risk families is important. This study focuses on longitudinal risk factors for child maltreatment and associations between abuse risk and occurrence. It also examines whether abuse risk and involvement in early childhood intervention are associated. The sample comprises 197 German caregivers with children under 3 years of age. Data was collected in two waves. The Brief Child Abuse Potential Inventory assessed abuse risk. Socio-demographic, parent, child and family-related risk factors were measured using screening tools. The analysis revealed that parental characteristics (psychopathology, own maltreatment experiences etc.) were associated with concurrent abuse risk. Longitudinal changes in abuse risk were linked to caregiver education and child-related factors. Cumulative risk did not explain more variance than specific risk factors. Significant associations with caregiverreported abuse were found, and data suggest that some burdened families cannot be reached by early childhood intervention.
Hintergrund:
Feedback von Patienten über erlebte Versorgungsaspekte erfolgt auch in der Rehabilitation inzwischen zunehmend online, beispielsweise auf Bewertungsportalen. Daher soll untersucht werden, welche von Rehabilitanden auf der für Reha-Kliniken führenden Bewertungsplattform Klinikbewertungen.de veröffentlichten Versorgungsaspekte mit der Weiterempfehlung einer Rehaklinik und welche negativen Aspekte mit der Nicht-Weiterempfehlung assoziiert sind.
Methode:
Eingeschlossen wurden Reha-Kliniken der Rentenversicherung Bund und federführend von ihr belegte Kliniken. Mit einem Mixed-Methods-Ansatz wurden aus acht Reha-Indikationsgruppen nach Zufriedenheitsstufen stratifizierte freitextliche Erfahrungsberichte von Rehabilitanden inhaltsanalytisch ausgewertet. Der Zusammenhang zwischen positiven (negativen) Aussagen mit der (Nicht-)Weiterempfehlung wurde in der jeweiligen Reha-Indikationsgruppe untersucht.
Ergebnisse:
Die Inhaltsanalyse von 911 Erfahrungsberichten ergab 20 thematische Kategorien. Der von Rehabilitanden wahrgenommene "Reha-Erfolg" war am häufigsten mit der Weiterempfehlung bzw. Nicht-Weiterempfehlung signifikant assoziiert. In fünf QS-Vergleichsgruppen war das Thema "Verpflegung" assoziiert. In allen QS-Vergleichsgruppen war mindestens ein prozessorientiertes Rehabilitationsthema assoziiert: "Reha-Maßnahmen", "Reha-Plan und Reha-Ziele" und/oder "Diagnose bis Entlassung".
Diskussion und Schlussfolgerung:
Reha-Kliniken können auf Basis der vorgestellten Ergebnisse indikationsspezifisch die für die Klinik-Weiterempfehlung relevanten Versorgungsaspekte identifizieren. Die Einbeziehung von Online-Erfahrungsberichten schafft zusätzliche Erkenntnisse über die Gründe der (Un-)Zufriedenheit von Rehabilitanden. Potenziellen Rehabilitanden steht das Erfahrungswissen als niederschwellige Informationsquelle und Entscheidungshilfe zur Verfügung
Wohnungslose Menschen wurden systematisch diskreditiert und werden immer noch systematisch ausgegrenzt. Die Angebote für wohnungslose Menschen sind unzureichend und lückenhaft. Die besonderen Erfahrungen und Bedürfnisse der Betroffenen müssen besser als bisher berücksichtigt werden um bedarfsgerechtere Hilfen und Angebote zu gestalten. Hierfür ist die Einbeziehungen der Betroffenen in Planung und Ausgestaltung der Angebote systematisch und unbefristet zu fördern. Um den Interessen der Betroffenen Gehör zu verschaffen sind entsprechende Ressourcen bereitzustellen und Kommunikationswege zu eröffnen.
Lack of knowledge regarding antibiotics use has been widely identified as a main reason for inappropriate antibiotics use which leads to antibiotic resistance phenomenon. This study aimed to evaluate the effects of pharmacist-initiated educational intervention on promoting appropriate use of antibiotics and reducing self-medication with antibiotics. A pre and post intervention study using two validated self-administered questionnaires was performed in Yogyakarta province. A-two hour session of course and case discussion was delivered as method of intervention. Pharmacy customers attended Gema Cermat program were invited conveniently to complete both of pre- and post-educational questionnaires. Descriptive presentation was conducted to show scores on questions. Knowledge scores were categorized as poor, adequate and high. Of 268 respondents, 34.22% respondents had poor level of knowledge before receiving educational intervention, but this number decreased into 12.21% after post-interventional phase. Another 28.23% respondents had adequate level of knowledge before and then elevated into 38.28% after receiving education about appropriate use of antibiotics. Pre-education, 37.43% participants had a high level of knowledge about antibiotics use and resistance, whereas after education the number became slightly higher (49.25%). A vast majority of respondents (75.24%) became more aware about appropriate antibiotics practice after receiving educational inter- vention. Overall, didactic educational intervention imposed higher knowledge and better practice regarding antibiotics use (p < 0.05). This study showed that using didactical education intervention towards antibiotics use and resistance can be an initial strategy that led to substantial improvement of appropriate antibiotics use. Further systemic interventions to educate people should be performed and evaluated in order to promote the appropriate use of antibiotics.
Worldwide, seagrass meadows are under threat. Consequently, there is a strong need for seagrass restoration to guarantee the provision of related ecosystem services such as nutrient cycling, carbon sequestration and habitat provision. Seagrass often grows in vast meadows in which the presence of seagrass itself leads to a reduction of hydrodynamic energy. By modifying the environment, seagrass thus serves as foundation species and ecosystem engineer improving habitat quality for itself and other species as well as positively affecting its own fitness. On the downside, this positive feedback mechanism can render natural recovery of vanished and destroyed seagrass meadows impossible. An innovative approach to promote positive feedback mechanisms in seagrass restoration is to create an artificial seagrass (ASG) that mimics the facilitation function of natural seagrass. ASG could provide a window of opportunity with respect to suitable hydrodynamic and light conditions as well as sediment stabilization to allow natural seagrass to re-establish. Here, we give an overview of challenges and open questions for the application of ASG to promote seagrass restoration based on experimental studies and restoration trials and we propose a general approach for the design of an ASG produced from biodegradable materials. Considering positive feedback mechanisms is crucial to support restoration attempts. ASG provides promising benefits when habitat conditions are too harsh for seagrass meadows to re-establish themselves.
Objectives: Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery.
Methods: We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery.
Results: In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia.
Conclusions: Tractography of language pathways can help to determine the individual aphasia risk profile presurgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.
Methods for standard meta-analysis of diagnostic test accuracy studies are well established and understood. For the more complex case in which studies report test accuracy across multiple thresholds, several approaches have recently been proposed. These are based on similar ideas, but make different assumptions. In this article, we apply four different approaches to data from a recent systematic review in the area of nephrology and compare the results. The four approaches use: a linear mixed effects model, a Bayesian multinomial random effects model, a time-to-event model and a nonparametric model, respectively. In the case study data, the accuracy of neutrophil gelatinase-associated lipocalin for the diagnosis of acute kidney injury was assessed in different scenarios, with sensitivity and specificity estimates available for three thresholds in each primary study. All approaches led to plausible and mostly similar summary results. However, we found considerable differences in results for some scenarios, for example, differences in the area under the receiver operating characteristic curve (AUC) of up to 0.13. The Bayesian approach tended to lead to the highest values of the AUC, and the nonparametric approach tended to produce the lowest values across the different scenarios. Though we recommend using these approaches, our findings motivate the need for a simulation study to explore optimal choice of method in various scenarios.
The objective of this study was to investigate the occurrence of bacteremia in dairy cows with severe mastitis. Milk samples were collected from affected udder quarters, and corresponding blood samples were collected from dairy cows with severe mastitis at the time of diagnosis before any therapeutic measures were undertaken. The cultural detection of pathogens in blood classified a bacteremia. Further diagnostic tests were performed to provide evidence of bacteremia. This was realized by PCR with regard to S. aureus, E. coli and S. uberis and the Limulus test. Detection of culturable pathogens in the blood of cows with severe clinical mastitis was rare and occurred in only one of 70 (1.4%) cases. Overall, bacterial growth was detected in 53 of 70 (75.7%) milk samples. S. uberis (22/70), E. coli (12/70) and S. aureus (4/70) were the most frequently isolated pathogens from milk of cows with severe mastitis. PCR was performed in 38 of 70 (54.3%) blood samples. PCR was positive in eight of 38 cases. S. uberis was found most frequently in six blood samples (8.6%). E. coli was found on PCR in one blood sample (1.4%). S. aureus was identified in one blood sample (1.4%). When Coliforms were detected in the quarter milk sample, a Limulus test was performed in the corresponding blood sample. In three of 15 cases, the Limulus test was positive (4.3% of samples). Further studies are needed to investigate the occurrence of bacteremia in cows with severe mastitis in a higher population size.
In den Frühen Hilfen und im Kinderschutz fehlen selektive und indizierte Präventionsmaßnahmen für Väter mit einem hohen Risiko für (wiederholte) Kindesmisshandlung. Das kanadische Caring Dads Programm wird seit 2008 in Deutschland eingesetzt. Ziel dieser Studie war es, Väter zu untersuchen, die bis 2016 an einem Caring Dads Programm in Düsseldorf, Hannover oder Groß-Gerau teilgenommen haben. Die Studie an n = 60 Vätern und n = 34 Müttern beinhaltete die Veränderungsmessung von selbstberichteter Aggressivität, Erziehungsverhalten und Co-Parenting der Väter sowie Lebensqualität und Co-Parenting der Mütter, den Vergleich von in Deutschland und Kanada teilnehmenden Vätern (n = 59/64) und eine postalische Katamnese (n = 20). Die Ergebnisse zeigen im Mittel Verbesserungen von väterlicher Aggressivität (d = .39) und Erziehungsverhalten (d = .80, normiert: φ = .46) sowie mütterlichem Co-Parenting (d = .46) und väterlichem Verhalten gegenüber der Partnerin aus Müttersicht (d = .47). Bei einem Viertel bis einem Drittel risikobelasteter Väter waren die Verbesserungen bei Kontrolle von Messfehlern mittels Reliable Change Index klinisch signifikant. Deutsche Väter berichteten eine höhere Änderungssensitivität (T1/T2: d = 1.37/1.59) und verbale Aggressivität (T1/T2: d = 1.29/1.36) verglichen mit kanadischen Vätern. Die Katamnese zeigt subjektiv bedeutsame Verbesserungen der Beziehungs- und Erziehungsqualität aus Vätersicht. Die Evaluation liefert keine Hinweise auf kulturbedingte Hürden bei der Implementierung von Caring Dads in Deutschland.