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Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.
Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.
Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
Adhärenz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen
(2021)
AbstractMany digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as “the degree to which the user followed the program as it was designed,” which can also be paraphrased as “intended use” or “use as it is designed.” However, both the theoretical–conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.
BACKGROUND Interest in digital technologies in the health care sector is growing and can be a way to reduce the burden on professional caregivers while helping people to become more independent. Social robots are regarded as a special form of technology that can be usefully applied in professional caregiving with the potential to focus on interpersonal contact. While implementation is progressing slowly, a debate on the concepts and applications of social robots in future care is necessary. OBJECTIVE In addition to existing studies with a focus on societal attitudes toward social robots, there is a need to understand the views of professional caregivers and patients. This study used desired future scenarios to collate the perspectives of experts and analyze the significance for developing the place of social robots in care. METHODS In February 2020, an expert workshop was held with 88 participants (health professionals and educators; [PhD] students of medicine, health care, professional care, and technology; patient advocates; software developers; government representatives; and research fellows) from Austria, Germany, and Switzerland. Using the scenario methodology, the possibilities of analog professional care (Analog Care), fully robotic professional care (Robotic Care), teams of robots and professional caregivers (Deep Care), and professional caregivers supported by robots (Smart Care) were discussed. The scenarios were used as a stimulus for the development of ideas about future professional caregiving. The discussion was evaluated using qualitative content analysis. RESULTS The majority of the experts were in favor of care in which people are supported by technology (Deep Care) and developed similar scenarios with a focus on dignity-centeredness. The discussions then focused on the steps necessary for its implementation, highlighting a strong need for the development of eHealth competence in society, a change in the training of professional caregivers, and cross-sectoral concepts. The experts also saw user acceptance as crucial to the use of robotics. This involves the acceptance of both professional caregivers and care recipients. CONCLUSIONS The literature review and subsequent workshop revealed how decision-making about the value of social robots depends on personal characteristics related to experience and values. There is therefore a strong need to recognize individual perspectives of care before social robots become an integrated part of care in the future.
Steigerung der Versorgungsqualität in der Palliativversorgung durch elektronische Gesundheitsakten
(2021)
This paper presents a seminar concept for the development of communication competence in pre-service vocational education teachers with the aid of video annotations, feedback, and peer microteaching. The seminar is offered within a teacher training program for students taking a master’s degree (MEd) in vocational education at the FH Münster University of Applied Sciences, Germany, and has been conducted three times. The advantages of the seminar concept are manifold. On the one hand, we create a learning environment in which students individually prepare and conduct five peer microteaching lessons in a row and receive prompt and constructive peer feedback on every performance. On the other hand, the quality of feedback improves so that our students are professional feedback providers by the end of the seminar. The provision of teacher feedback alone does not help our students become successful feedback providers. Nor, given the resources available at the university, is it a realistic alternative in terms of time constraints. In addition, due to recordings, the students gain a better insight into their teaching skills since their lessons can be observed and approached from an outside perspective.
A synthesis is made of 10 topics within climate research, where there have been significant advances since January 2020. The insights are based on input from an international open call with broad disciplinary scope. Findings include: (1) the options to still keep global warming below 1.5 °C; (2) the impact of non-CO2 factors in global warming; (3) a new dimension of fire extremes forced by climate change; (4) the increasing pressure on interconnected climate tipping elements; (5) the dimensions of climate justice; (6) political challenges impeding the effectiveness of carbon pricing; (7) demand-side solutions as vehicles of climate mitigation; (8) the potentials and caveats of nature-based solutions; (9) how building resilience of marine ecosystems is possible; and (10) that the costs of climate change mitigation policies can be more than justified by the benefits to the health of humans and nature.
As a salutogenic concept, “consumption corridors” aims to support what is necessary for sustainable wellbeing to be achieved in relation to the Earth system, with a deep consideration for justice and equity. Living in consumption corridors is a representation of everyday life whereby people live within limits, so that all people – now and in the future – can access what is needed to live a good life. In this special issue, a series of scholars and practitioners have come together to further develop the concept, engage with its ethodological implications, and relate it to consumption domains and policy implications. We begin by introducing how the concept emerged, in relation to the complexity of grappling with the societal transformations required for achieving more sustainable forms of consumption. We then present the different contributions, which demonstrate the importance of considering both maximum and minimum consumption standards, the relevance of human-need theories, as well as the difference between achieving wellbeing and the means necessary for doing so. We conclude by opening up to areas that merit further deliberation: how to relate consumption corridors to everyday-life dynamics, but also to the critical question of power relations at play in implementing consumption corridors.
The quantum anomaly is written alternatively into a form violating conservation laws or as non-gauge invariant currents seen explicitly on the example of chiral anomaly. By reinterpreting the many-body averaging, the connection to Pauli–Villars regularization is established which gives the anomalous term a new interpretation as arising from quantum fluctuations by many-body correlations at short distances. This is exemplified using an effective many-body quantum potential which realizes quantum Slater sums by classical calculations. It is shown that these quantum potentials avoid the quantum anomaly but approach the same anomalous result by many-body correlations. Consequently, quantum anomalies might be a shortcut way of single-particle field theory to account for many-body effects. This conjecture is also supported since the chiral anomaly can be derived by a completely conserving quantum kinetic theory. A measure for the quality of quantum potentials is suggested to describe these quantum fluctuations in the mean energy. The derived quantum potentials might be used to describe quantum simulations in classical terms.
Experimental results are presented of a test of the theory of local turbulent heat transfer measurements proposed by Mocikat and Herwig in 2007. A miniaturized multi-layer heat transfer sensor was developed and employed in this study. The new heat transfer sensor was designed to work in air and liquids, and this capability enabled the simultaneous investigation of different Prandtl numbers. Two basic configurations, namely the flow past a blunt plate and the flow past an inclined square cylinder, were investigated in test sections of wind and water tunnels. Convective heat transfer coefficients were obtained through conventional testing (i.e., employing thoroughly heated test objects) and using the new miniaturized sensor approach (i.e., utilizing cold test objects without heating). The main prediction of the Mocikat-Herwig theory that a specific thermal adjustment coefficient of the employed actual miniaturized heat transfer sensor should exist in the fully turbulent flow regime was proven for developed two-dimensional flow. The observed effect of the Prandtl number on this coefficient was in good agreement with the prediction of the asymptotic expansion method. The square cylinder results indicated the inherent limits of the local turbulent heat transfer measurement approach, as suggested by Mocikat and Herwig.
Food-processing companies are controlled by societal influences and economic interests, but their efforts with regard to reducing food loss and waste are very different. This qualitative study aims to identify basic recommendations of good practice for the food-processing industry in order to prevent and handle food loss and waste. For this purpose, a comprehensive literature review was conducted in the field of food waste prevention and data was collected from thirteen German companies. The findings summarize the recommendations of good practice, which cover the entire supply chain from supplier to consumer and beyond. The analysis showed that the participating companies are already partially aware of operational measures, even if they are applied or mentioned without a systematic approach. Furthermore, the analysis revealed that most activities relate to internal matters, like processing, employees and utilization. However, the responsibility of foodprocessing companies does not end with internal processes to reduce food waste. The results show that some companies are already aware of their responsibility to be involved along the entire supply chain. Finally, the results show that the needs of consumers and suppliers must also be considered in order to reduce food waste, in addition to direct reduction measures. This paper highlights nine important stages and 53 basic recommendations for companies to address food loss and waste in order to improve their practices.
(1) Background: Schools report a high number of schoolchildren with poor attention and hyperactive behavior, with 5% being diagnosed with attention deficit/hyperactivity disorder (ADHD). This causes specific problems during homework and classroom times, and the extension of all-day schooling in German primary schools makes this a challenge for support staff working in the after-school programs. Such staff have a very wide variety of qualifications, ranging from no formal teacher training to full teaching qualifications. (2) Methods: This study documents the knowledge of 196 support staff working in all-day primary schools about ADHD, and their subjective view of whether they feel competent with regard to homework situations in general and ADHD in particular. (3) Results: Those with an educational background have significantly more knowledge than those without such a background, staff feel less prepared to supervise children with ADHD, and there is a small but significant correlation here with knowledge about ADHD. (4) Conclusions: The importance of trained pedagogical staff in the supervision of children with concentration problems is emphasized.
Background. Ketone bodies are a highly relevant topic in nutrition and medicine. -e influence of medium-chain triglycerides (MCT) on ketogenesis is well known and has been successfully used in ketogenic diets for many years. Nevertheless, the effects of MCTs and coconut oil on the production of ketone bodies have only partially been investigated. Furthermore, the increased mobilisation of free fatty acids and release of catabolic hormones by caffeine suggest an influence of caffeine on ketogenesis.
Methods. In a controlled, double-blind intervention study, seven young healthy subjects received 10mL of tricaprylin (C8), tricaprin (C10), C8/C10 (50% C8, 50% C10), or coconut oil with or without 150 mg of caffeine, in 250mL of decaffeinated coffee, over ten interventions. At baseline and after every 40 minutes, for 4 h, ßHB and glucose in capillary blood as well as caffeine in saliva were measured. Furthermore, questionnaires were used to survey sensory properties, side effects, and awareness of hunger and satiety. Results. -e interventions with caffeine caused an increase in ßHB levels—in particular, the interventions with C8 highly impacted ketogenesis. -e effect decreased with increased chain lengths. All interventions showed a continuous increase in hunger and diminishing satiety. Mild side effects (total � 12) occurred during the interventions. Conclusions. -e present study demonstrated an influence of caffeine and MCTon ketogenesis. -eaddition of caffeine showed an additive effect on the ketogenic potential of MCT and coconut oil. C8 showed the highest ketogenicity.
Different from negatively charged CuInS2 (CIS) based quantum dots (QDs), positively charged QDs are difficult to obtain in good optical quality, but are desirable for certain applications. We herein present a general synthesis strategy that allows for a universal surface modification of ternary CIS based QDs with thiol containing ligands.
The idea behind the synthesis design is, to apply a ZnS shell first for passivating and protecting the core QDs, and then add a second ZnS shell for the functionalization via ligand exchange. Whereby easy ligand exchange with thiolated molecules is systematically set up, by using a weak bonding amine ligand for the second shell. Molecules with various terminal groups were used to functionalize the nanoparticles and stabilize them in different media making any surface charge and polarity accessible. Surface defect chemistry seemed to play an important role in our synthesis strategy, therefore to gain a deeper understanding how these defect sites can alter the electronic structure of core/shell nanoparticles theoretical calculations based on density functional theory were performed, whilst structural, colloidal and optical properties were characterized experimentally (by dynamic light scattering, x-ray diffraction, infrared spectroscopy, zeta potential, absorption- and (time resolved) photoluminescence
measurements).
Cross-saturation of the gain media in intra-cavity pumped lasers leads to complex dynamics of the laser power. We present experimental results and a detailed theoretical analysis of this nonlinear dynamics for an intra-cavity pumped Yb:YAG thin-disk laser in the framework of a rate-equation model. The gain medium of this laser is residing in the resonator of a conventional, diode-pumped Yb:YAG thin-disk laser. Continuous-wave operation, periodic pulse trains, and chaotic fluctuations of the optical power of both lasers were observed. The dynamics is not driven by external perturbations but arises naturally in this laser system. Further examination revealed that these modes of operation can be controlled by the resonator length of the diode-pumped laser but that the system can also show hysteresis and multi-stability.
Male juveniles in segregated poor neighbourhoods are at increased risk of violence. The code of the street approach is commonly used to understand the context informing street violence in such marginalized spaces, but the concept is mainly used in Western countries, especially in African American communities in the US. This study investigates whether the code of the street is also applicable to the largest Roma neighbourhood in Europe, located in Bulgaria, through guided interviews with male juveniles. The results show that some elements of the code work are applicable in this space, but clear differences also emerge. These findings affect the generalizability of the approach and the understanding of street violence.