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Das Thema «Betriebswirtschaftslehre«gewinnt auch im gesamten Feld der sozialen Arbeit immer mehr an Bedeutung. Betriebswirtschaftliche Denkmodelle bestimmen zunehmend auch die Reformdiskussion in der Jugendhilfe. Im Folgenden wird zum einen auf die Besonderheiten der betriebswirtschaftlichen Steuerung von Maßnahmen im Jugendhilfebereich eingegangen, wie auch anhand eines Beispiels eine Kosten-Nutzen-Analyse von Jugendhilfemaßnahmen dargestellt wird. Kosten-Nutzen-Analysen ermöglichen eine Bewertung der Effizienz von Jugendhilfemaßnahmen. Gerade vor dem Hintergrund»leerer«Staatskassen ist es dringend erforderlich, dass die positiven Effekte der Jugendhilfe auf die gesamtwirtschaftliche Entwicklung dargestellt werden.
Informierst du noch - oder lässt du schon mitbestimmen? Ein Stufenmodell partizipativen Arbeitens.
(2017)
Der Beitrag setzt sich mit generellen und fachspezifischen Gründen und Rahmenbedingungen auseinander, die zu geschlechterdifferenzierenden Zugängen zur Promotion führen. Auch die Bedeutung von Geschlecht im Prozess des Promovierens wird dabei berücksichtigt. Ziel ist das Aufzeigen von Möglichkeiten, wie eine gelingende und chancengerechte Förderung von promotionsinteressierten und promovierenden Absolventinnen Sozialer Arbeit an Hochschulen aussehen könnte und sollte. Hierzu werden aktuelle Daten zur Einschätzung der Situation beleuchtet, geschlechtertheoretische Erklärungsansätze fokussiert sowie Praxisbeispiele zur weiblichen Nachwuchsförderung und Kurzportraits weiblicher Promovierender an Hochschulen exemplarisch vorgestellt.
Offene Arbeit mit Kindern
(2015)
Im Rahmen der vorliegenden Dissertation werden förderliche und hemmende Faktoren im Erreichen einer Leitungsposition von Frauen analysiert. Der besondere Fokus ist dabei auf die obere Führungsebene in Organisationen der Sozialen Arbeit gerichtet, im Besonderen auf die Freie Wohlfahrtspflege. Ziel ist darüber hinaus die Darstellung von Handlungsimplikationen zur Förderung weiblicher Karrieren in der Sozialen Arbeit, als Beitrag zur besseren Nutzung weiblichen Know-Hows. Die Arbeit berücksichtigt dabei sowohl die Sicht von Frauen in Führungspositionen, als auch die Sicht von Personalentscheiderinnen und -entscheidern und leistet einen Beitrag dazu, wie Frauen in Verbänden und Organisationen der Freien Wohlfahrtspflege der Zugang zu Führungspositionen ermöglicht werden kann.
Ministerien
(2015)
Familienbildungsstätte
(2015)
Konzept
(2015)
Spenden
(2015)
Waldpädagogik
(2015)
Kindertagesstätte
(2015)
Krippe
(2015)
Montessori-Pädagogik
(2015)
Lexikon Kita-Management
(2015)
Die Elementarpädagogik befindet sich im Wandel. Die Kita gilt nicht mehr nur als Betreuungsort, im Vordergrund steht zunehmend die Bildungsarbeit. Dieses Lexikon gibt Ihnen einen Überblick über die wichtigsten Begriffe im Bereich Kita-Management.
Die gesellschaftlichen Änderungen beeinflussen Ihre Arbeit im Kita-Alltag massiv: Chancengleichheit bei kulturellen und sozialen Unterschieden, Vereinbarkeit von Familie und Beruf bei zunehmendem Fachkräftemangel und viele weitere äußere Einflüsse.
In diesem Buch werden wichtige Fachbegriffe von Anforderungsprofil bis Zeitmanagement und aktuelle Fragestellungen praxisnah und auf Ihren Alltag zugeschnitten behandelt. Ob zum einfachen Nachschlagen oder zum Vertiefen der Grundkenntnisse, das Lexikon Kita-Management bieten Ihnen mit seinen übersichtlich aufgebauten Artikeln einen idealen Begleiter für Ihren täglichen Arbeitsalltag.
Erziehungspartnerschaft.
(2015)
Fundraising
(2015)
Innovationen
(2015)
Museumspädagogik
(2015)
Sozialer Raum
(2015)
Zur Methodik einer zielgerichteten Evaluation der Vernetzung im Sozialraum: Zum Ausbau der sozialräumlichen Vernetzung müssen Kitas zunächst neben dem aktuellen Stand auch ermitteln, an welchen Stellen Verbesserungsbedarf besteht. Maßgebend für eine gewinnbringende Evaluation ist neben der Auswahl geeigneter Evaluationsmethoden die genaue Klärung der Evaluationsziele. Im Kita-Bereich erfährt Evaluation zunehmend an Bedeutung – aus politischen und professionsbezogenen Gründen. Theoretische Vorüberlegungen und Grundlagen sind weitgehend bekannt, sodass im folgenden Beitrag die Anwendung von Evaluation im sozialräumlichen Arbeiten von Kitas fokussiert wird.
Aufgrund von Veränderungen, die mit dem sozialen Wandel einhergehen, steht auch die Freie Wohlfahrtspflege vor der Herausforderung, sich auf neue Zielgruppen einzustellen und/ oder neue Methoden anzuwenden. Gründe, Innovationen zu entwickeln, sind demnach vielfältig und resultieren in der Regel aus einem Wechselspiel zwischen Verständnis als originäre Aufgabe, Legitimation und Wettbewerbsvorteil. Zugrunde liegt stets eine Sensibilität für und das Aufgreifen von gesellschaftlichen Problemlagen. Konkrete Praxisbeispiele geben Einblick in Gestaltungsmöglichkeiten innovativer Angebote.
Former economic analyses have shown that universal mass vaccination of infants against varicella using a one-dose schedule is cost-saving in Germany. In July 2006, an MMRV combination vaccine has been approved in Germany which shall be given in a two-dose schedule. We re-analysed our former analysis with the EVITA model in order to prove whether our former conclusion that universal mass vaccination against varicella is cost-saving is still valid when using a two-dose schedule vaccine. Indeed we found that universal mass vaccination of infants against varicella with a two-dose vaccine is cost-saving from societal as well as from health care perspective.
As part of international efforts to develop and implement national models including the specification of ICF-based clinical data collection tools, the Italian rehabilitation community initiated a project to develop simple, intuitive descriptions of the ICF Rehabilitation Set, highlighting the core concept of each category in user-friendly language.
This paper outlines the Italian experience in developing simple, intuitive descriptions of the ICF Rehabilitation Set as an ICF-based clinical data collection tool for Italy.Consensus process.Expert conference.
Multidisciplinary group of rehabilitation professionals.The first of a two-stage consensus process involved developing an initial proposal for simple, intuitive descriptions of each ICF Rehabilitation Set category based on descriptions generated in a similar process in China.
Stage two involved a consensus conference. Divided into three working groups, participants discussed and voted (vote A) whether the initially proposed descriptions of each ICF Rehabilitation Set category was simple and intuitive enough for use in daily practice.
Afterwards the categories with descriptions considered ambiguous i.e. not simple and intuitive enough, were divided among the working groups, who were asked to propose a new description for the allocated categories. These proposals were then voted (vote B) on in a plenary session.
The last step of the consensus conference required each working group to develop a new proposal for each and the same categories with descriptions still considered ambiguous.
Participants then voted (final vote) for which of the three proposed descriptions they preferred.Nineteen clinicians from diverse rehabilitation disciplines from various regions of Italy participated in the consensus process. Three ICF categories already achieved consensus in vote A, while 20 ICF categories were accepted in vote B.
The remaining 7 categories were decided in the final vote.The findings were discussed in light of current efforts toward developing strategies for ICF implementation, specifically for the application of an ICF-based clinical data collection tool, not only for Italy but also for the rest of Europe.
Promising as minimal standards for monitoring the impact of interventions and for standardized reporting of functioning as a relevant outcome in rehabilitation.
Objective: The aims of this study were to evaluate the feasibility of using the International Classification of Functioning, Disability and Health (ICF) Generic Set in routine clinical practice, and of creating a functioning score based on it, and, subsequently, to examine its sensitivity to change.
Methods: In this prospective cohort study, data from 761 adult inpatients from 21 Chinese hospitals were analysed. Each patient was assessed at admission and discharge. Feasibility was evaluated by analysing mean assessment time. The Rasch model was used to create a metric of functioning. Sensitivity to change was analysed with mixed-effects regression and by calculating standardized effect size based on Cohen's f2.
Results: Mean duration of assessment was 5.3 min, with a significant decrease between admission and discharge. After removal of the item remunerative employment, the remaining ICF Generic Set categories fitted the Rasch model well. With a mean improvement in functioning of 12.1 (95% confidence interval (95% CI): 11.5–12.6), this metric proved sensitive to change, both in terms of statistical significance (p < 0.001) and standardized effect size (Cohen's f2 = 2.35).
Discussion: The ICF Generic Set is feasible for use in routine clinical practice and is promising to serve as the basis for the development of a functioning score that is sensitive to change.
Die Kita im Sozialraum
(2019)
„Das Zusammenspiel unterschiedlicher Bildungsakteure und -gelegenheiten ist sozialräumlich auszugestalten und in kommunaler Verantwortung zu organisieren.“ (BMFSFJ 2006, 351). Der 12. Kinder- und Jugendbericht benennt damit eine Herausforderung, die es für den Aufbau eines integrierten Systems von Bildung, Betreuung und Erziehung auch für Kitas zu bewältigen gilt. Der folgende Text soll daher die Bedeutung sozialräumlichen Handelns und Gelingensfaktoren aufzeigen sowie methodische Ansätze und Handlungsempfehlungen zur Analyse des Sozialraums sowie zur Vernetzung im Sinne einer Bildungslandschaft geben.
Soziale Arbeit leistet einen Beitrag zu mehr sozialer Gerechtigkeit und zum Abbau sozialer Ungleichheit in der Gesellschaft, gleichzeitig gewinnt Gesundheit als Dimension sozialer Ungleichheit zunehmend an Bedeutung. Als Beispiele hierfür können chronische Erkrankungen, Behinderung und Pflegebedürftigkeit genannt werden, die häufig eine gleichberechtigte Teilhabe an der Gesellschaft erschweren, wodurch gesundheitliche Ungleichheit zu sozialer Ungleichheit führt beziehungsweise diese verstärkt. Fragestellungen zu Themen der Gesundheit haben demnach in vielfältiger Hinsicht auch Bezug auf Soziale Arbeit.
Elterninitiativen
(2015)
One aspect of voice and speech evaluation after laryngeal cancer is acoustic analysis. Perceptual evaluation by expert raters is a standard in the clinical environment for global criteria such as overall quality or intelligibility. So far, automatic approaches evaluate acoustic properties of pathologic voices based on voiced/unvoiced distinction and fundamental frequency analysis of sustained vowels. Because of the high amount of noisy components and the increasing aperiodicity of highly pathologic voices, a fully automatic analysis of fundamental frequency is difficult. We introduce a purely data-driven system for the acoustic analysis of pathologic voices based on recordings of a standard text.
Growing evidence shows interrelations of psychological factors, neurological and immunological processes. Therefore, constructs like a balance of activities, the so called “occupational balance”, could also have biological correlates. The aim of this study was to investigate potential associations between occupational balance, functioning, cytokines and C-reactive protein (CRP) in patients suffering from a chronic inflammatory disease like rheumatoid arthritis (RA) and healthy people. Moreover, we wanted to explore potential differences in gender and employment status.
A descriptive study in patients with RA and healthy people was conducted using the Occupational Balance-Questionnaire (OB-Quest) and the Short-Form 36 Health Survey (SF-36). Serum levels of cytokines, such as interleukin 6 (IL-6) and 8 (IL-8), interferon alpha (INFα), tumour necrosis factor alpha (TNFα), rheumatoid factor (RF) and of CRP were measured. Descriptive statistics, as well as Mann-Whitney U tests and Spearmen's rank correlation coefficients (rs) were calculated.
One-hundred-thirty-two patients with RA and 76 healthy people participated. Occupational balance was associated with functioning, cytokines and CRP. The strongest associations were identified in the unemployed healthy-people sample with cytokines and CRP being within the normal range. For example, the OB-Quest item challenging activities was associated with IL-8 (rs = − 0.63, p = 0.04) and the SF-36 sub-scale bodily pain was associated with IFNα (rs = − 0.69, p = 0.02). The items rest and sleep (rs = − 0.71, p = 0.01) and variety of different activities (rs = − 0.74, p < 0.01) correlated with the SF-36 sub-scale social functioning. Employed and unemployed people differed in their age and CRP levels. Additionally, gender differences were found in two OB-Quest items in that fewer women were able to adapt their activities to changing living conditions and fewer men were overstressed. In conclusion, we found preliminary biological evidence for the link between occupation and health in that the concepts encompassed in the construct of occupational balance were associated with functioning, cytokines and CRP.
Background
Self-reported outcome instruments in health research have become increasingly important over the last decades. Occupational therapy interventions often focus on occupational balance. However, instruments to measure occupational balance are scarce. The aim of the study was therefore to develop a generic self-reported outcome instrument to assess occupational balance based on the experiences of patients and healthy people including an examination of its psychometric properties.
Methods
We conducted a qualitative analysis of the life stories of 90 people with and without chronic autoimmune diseases to identify components of occupational balance. Based on these components, the Occupational Balance-Questionnaire (OB-Quest) was developed. Construct validity and internal consistency of the OB-Quest were examined in quantitative data. We used Rasch analyses to determine overall fit of the items to the Rasch model, person separation index and potential differential item functioning. Dimensionality testing was conducted by the use of t-tests and Cronbach’s alpha.
Results
The following components emerged from the qualitative analyses: challenging and relaxing activities, activities with acknowledgement by the individual and by the sociocultural context, impact of health condition on activities, involvement in stressful activities and fewer stressing activities, rest and sleep, variety of activities, adaptation of activities according to changed living conditions and activities intended to care for oneself and for others. Based on these, the seven items of the questionnaire (OB-Quest) were developed. 251 people (132 with rheumatoid arthritis, 43 with systematic lupus erythematous and 76 healthy) filled in the OB-Quest. Dimensionality testing indicated multidimensionality of the questionnaire (t = 0.58, and 1.66 after item reduction, non-significant). The item on the component rest and sleep showed differential item functioning (health condition and age). Person separation index was 0.51. Cronbach’s alpha changed from 0.38 to 0.57 after deleting two items.
Conclusions
This questionnaire includes new items addressing components of occupational balance meaningful to patients and healthy people which have not been measured so far. The reduction of two items of the OB-Quest showed improved internal consistency. The multidimensionality of the questionnaire indicates the need for a summary of several components into subscales.
The International Spinal Cord Injury (InSCI) community survey has been developed to collect internationally comparable data on the lived experience of persons with spinal cord injury (SCI) in all 6 WHO regions.
The InSCI survey provides a crucial first step to generate evidence on functioning, health maintenance, and subjective well-being in persons with SCI globally.
A major challenge in setting up the InSCI community survey was to develop a data model and questionnaire that comprehensively captures what matters to people and, at the same time, is feasible and parsimonious in terms of participant’s burden.
This paper outlines the components of the InSCI data model and presents the question selection to operationalize the data model along the 4 guiding principles of efficiency, feasibility, comparability, and truth and discrimination.
The data model consists of 6 components operationalized with 125 questions including functioning (n = 28 body functions and structures; n = 42 activities and participation), contextual factors (n = 26 environmental; n = 19 personal factors), lesion characteristics (n = 2), and appraisal of health and well-being (n = 8).
The InSCI questionnaire presents an efficient and feasible solution with satisfying comparability to other populations; however, its validity and reliability still needs to be confirmed.
Purpose
The content of and methods for collecting health information often vary across settings and challenge the comparability of health information across time, individuals or populations. The International Classification of Functioning, Disability and Health (ICF) contains an exhaustive set of categories of information which constitutes a unified and consistent language of human functioning suitable as a reference for comparing health information.
Methods and results In two earlier papers, we have proposed rules for linking existing health information to the ICF. Further refinements to these existing ICF Linking Rules are presented in this paper to enhance the transparency of the linking process. The refinements involve preparing information for linking, perspectives from which information is collected and the categorization of response options. Issues regarding the linking of information not covered or unspecified within the ICF are also revisited in this paper.
Conclusion:
The ICF Linking Rules are valuable for enhancing comparability of health information to ensure that information is available in a consistent manner to serve as a foundation for evidence-based decision-making across all levels of health systems. The refinements presented in this paper enhance transparency in, and ultimately reliability of the process of, linking health information to the ICF.
Implications for Rehabilitation
The International Classification of Functioning, Disability and Health (ICF) constitutes a unified and consistent language of human functioning suitable as a reference for comparing health information.
Comparability of information is essential to ensure that the widest range of information is available in a consistent manner for any decision-maker at all levels of the health system.
The refined ICF Linking Rules presented in this article outline the method to establish comparability of health information based on the ICF.
Background
acquired joint contractures have significant effects on quality of life and functioning.
Objective
to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures.
Methods
systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal.
Results
seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed.
Conclusion
the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.
Betriebliche Prozesse
(2010)
In this methodological note on applying the ICF in rehabilitation, we introduce suitable tools that allow us to document comprehensively and systematically the lived experience of health to guide clinical practice, the management of services, evidence-informed policy and scientific inquiry.
The objective of this methodological note is to present the currently available tools with respect to four questions: 1) what ICF domains to document; 2) what perspective to take; 3) what data collection tools to apply; and 4) which approach to use for reporting. The application of these tools is illustrated using the Swiss Spinal Cord Injury (SwiSCI) Cohort Study.
Existing ICF Sets provide a practical approach for identifying the domains to document. One can document from the perspective of biological health, lived health, and appraised health. For identifying suitable data collection tools, either existing tools can be linked to the ICF or available ICF-based data collection tools can be used.
For reporting, an interval scale metric is suggested. The four step approach presented provides users with a logical sequence to follow when planning the documentation of functioning using the ICF as a health information reference system in practice and research.
Introduction Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality.
However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients’ needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing.
Objective The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) .
Methods Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA.
Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals.
Ethics and dissemination The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.
The System HAILsens implements a device for Real-Time sensor data processing, running on a Texas Instruments Concerto M3 core. An I2C interface is used for sensor communications. Ethernet with UDP on a custom developed three layered frame organisation of sensor data serves as a link to the main system on board of an aeroplane. For backing up the acquired data, all frames are locally stored on an SD Card. To have the possibility of easily checking the current system status, an LCD module and a push-button provide a minimal user interface.
Zahlensysteme und binäre Arithmetik
Nachricht und Information
Codierung und Datenkompression
Verschlüsselung
Schaltalgebra, Schaltnetze und Elemente der Computerhardware
Rechnerarchitekturen
Rechnernetze
Betriebssysteme
Datenbanken
Automatentheorie und formale Sprachen
Berechenbarkeit und Komplexität
Suchen und Sortieren
Bäume und Graphen
prozedurale und objektorientierte Programmierung (C und Java)
Anwendungsprogrammierung im Internet (HTML, CSS, JavaScript und PHP)
Software-Engineering
This paper deals with the preparation of the Small GEO mission and the accommodation of a GPS receiver as an experiment. The expected benefits of using the GPS receiver for Small GEO are explained. The feasibility of using GPS for position determination is investigated by simulation using a MosaicGNSS receiver, which was stimulated by a Spirent RF signal generator. A procedure, how to evaluate flight data on ground is outlined. Success criteria of the experiment and the minimal size of the downlink stream required and reserved for the receiver TM are presented.
The advanced Attitude and Orbit Control System (AOCS) design of the Small GEO platform is now being adapted for the first commercial mission.
The Small GEO telecommunications satellite is a new development to fill a niche in the telecom industry for small platforms weighing about 1.5 tonnes and targeting payloads of 300 kg and 3 kW. The first mission will launch into Geostationary Transfer Orbit (GTO).
Small GEO is being developed by a Consortium led by OHBSystem AG. The Swedish Space Corporation is a partner in the Consortium and supplies the AOCS and Electric Propulsion (EP) subsystems. The project is currently in Phase C and the first mission will fly in 2012. This article gives an overview of the AOCS development status.
The AOCS architecture is a three-axis stabilized system using reaction wheels for attitude control, star trackers for attitude determination, and EP for orbit control. The AOCS software is being developed using model-based design techniques and test driven development. Results from subsystem level testing of flight code will be presented.
The AOCS design is characterized by a number of advances in technology beyond traditional telecom satellite designs. Perhaps the largest deviation from a traditional design is complete reliance on EP for orbit control. Angular momentum management of the reaction wheels relies solely upon EP in the nominal modes. The EP is not used in the safe modes and therefore a cold gas system is included On-board.
The cold gas system uses Xenon, the same fuel used by the EP. Another advance is the reliance upon APS-based star trackers. APS (Active Pixel Sensor) star trackers have a number of advantages over their CCD-based cousins in terms of robustness. The traditional fine sun sensor is simplified to a fault tolerant system of solar cells giving low, but more than adequate, accuracy.
In addition, a GPS sensor will be flown on-board as an experiment.
Die wachsenden Anforderungen an Beschäftigte in Kitas lassen nicht nur für älter werdende Fachkräfte das Thema Gesundheit als zentralen Punkt für Träger und Leitung erkennen. Die Förderung von Gesundheit im Betrieb stellt daher eine „moderne Unternehmensstrategie dar und zielt darauf ab, Krankheiten am Arbeitsplatz vorzubeugen […], Gesundheitspotentiale zu stärken und das Wohlbefinden am Arbeitsplatz zu verbessern." (ENWHP 2007, S. 3). Unter dem Begriff Gesundheitsmanagement sollen daher im folgenden Beitrag Maßnahmen und Angebote verstanden werden, die als betriebliches Gesundheitsmanagement in Organisationen in unterschiedlichen Kontexten die Gesundheit von Beschäftigten fördern.
Agenda:
Studienziel Software-Ingenieur(in) Projekte im Rahmen des Informatik-Studiums Projektbeispiele -IT Partner in Forschungsprojekten
Labor für Software-Technik
-IT Partner in Forschungsprojekten -Einzelanfertigungen für genau einen Kunden -Unterstützung von Startups / Testen von Geschäftsideen -Projekte mit kleinen und mittleren Unternehmen Zusammenarbeit mit FH: Nächste Schritte
Aktuelle Projekte werden nur noch selten von einem einzigen Team an einem einzigen Standort bearbeitet. Um verteilt arbeitende Teams, Auftrag- und Unterauftragnehmer zu koordinieren, ist einerseits ein abgestimmtes Vorgehen notwendig, andererseits müssen Projekte in solchen Szenarios durch Werkzeuge unterstützt werden.
Die problemorientierte und organisationsspezifische Integration von Werkzeugen und Vorgehensmodellen ist ein wesentliches Erfolgskriterium für Organisationen und ihre Projekte. Werkzeuge können Anwender unterstützen und durch vorgegebene Prozesse wie z.B. Risikomanagement oder Berichtswesen führen. Eine nahtlose Integration eines Vorgehensmodells in eine gegebene und akzeptierte Werkzeugumgebung kann sich positiv auf den Erfolg von Prozessanpassungen auswirken.
Effizienzsteigerungen, bspw. durch die automatische Generierung von Vorlagen oder Dokumentation, machen Werkzeugintegrierte Prozesse auch für Entwickler interessant. Auf der anderen Seite müssen Projektspezifische Anforderungen an Werkzeuge und Prozesse berücksichtigt werden, die eine Flexibilität in der Anwendung und Benutzung erforderlich machen.
Dieser 3. Workshop diskutiert in Fortsetzung der Workshops Formalisierung und Anwendung sowie Reife und Qualität unterschiedliche und facettenreiche Fragen, die sich hinsichtlich der Werkzeugunterstützung und der werkzeuggeführten Anwendung von Vorgehensmodellen ergeben. Insbesondere die semi- und vollautomatische Integration von Vorgehensmodellen, die Generierung von Arbeitsumgebungen und Optionen zur Anwenderunterstützung und Anwenderführung spielen hier zentrale Rollen.
Im Zentrum des Workshops steht der Lifecycle von Vorgehensmodellen mit dem Schwerpunkt der Operationalisierung durch Werkzeuge und der geführten/unterstützten Anwendung. Von besonderem Interesse sind Fragen nach der Konzeption und Durchführung von Werkzeugen und Anwenderunterstützung im Kontext verschiedener Vorgehensmodelle, wie bspw. dem V-Modell XT, Scrum, Prince2, RUP, XP.
Themenüberblick:
Der 1-täige Workshop zielt im Wesentlichen auf folgende Themen:
Verbesserung der Akzeptanz von Vorgehensmodellen
Werkzeugunterstützte Prozesseinführung:
Einführung und Einführbarkeit mithilfe von Werkzeugen
Etablierung und Durchsetzung, Do's und Dont's
Kontinuierliche werkzeugunterstützte Prozessverbesserung
Kosten und Nutzen, Abhängigkeiten, Vor- und Nachteile
Werkzeugunterstützung bei der Projektdurchführung
Lose gekoppelte Werkzeuglandschaften vs. integrierte Tools
Werkzeugunterstützte Planung, Steuerung von Agilen Projekten
Unterstützung für kleine, große und verteilte Teams
Werkzeugunterstützung bei Auswahl, Anpassung und Tailoring
Grenzen der Werkzeugunterstützung
Formalisierung und Werkzeugunterstützung von Prozessen und Prozessschritten
Vorgehens- und Reifegradmodelle: V-Model XT, XP, CMMI, RUP, Scrum etc.
Nowadays, in software development usually various models and description fragments are created. Some of these artifacts describe the core of the application, such as the data model or the user interaction model. Other artifacts describe cross-cutting concerns, such as security or the requirement: “every change of data has to be confirmed by the user, before it is written into the database”. During the development process these artifacts are combined, transformed, and finally implemented manually or even automatically. For instance a designer may combine a model of a dialog component specifying an action, that changes data, with a common description of a generic confirm dialog. The integrated dialog description may be afterwards implemented by a programmer. The manual combination of both artifacts and the transformation of the combined description into code are errorprone and hard to change. Industry basically tests or actually uses two approaches for the combination today: 1. At the level of code and execution Aspect-Oriented Programming (AOP) is used [KLM+97]. An aspect defines a cross-cutting concern and the weaving instructions. A code weaver provides the actual weaving at compile or runtime. 2. At the level of design models and analysis models Model-Driven Software Development (MDSD) is used [KWB03]. A model in MDSD is a first class development artifact. Thus models are significantly more abstract than the implementation of code. However, these models cannot be executed. Hence, a abstract model is transformed into another, typically more detailed. A series of such transformations results in executable code. Thereby, a model transformer or a code generator reads some of the artifacts. The other artifacts and the combination rules are implemented in transformation rules or code generation templates (or somewhere else in the transformation / generation approach).
Components and component-based technologies (componentware) are well-known and widely used in software development. There is a large amount of work and research in componentware. The number of available componentware approaches increases steadily and it is quite difficult to keep track of current trends in this area. In this paper, we survey the current state of the art in componentware, introduce and compare several well-known componentware approaches and classify them according to outstanding characteristics. We discuss a list of open issues in resarch and practical use of componentware and offer some proposals for further development. In our practical considerations we focus on embedded systems and business information systems because most of our partners in industry work in one of these two domains. We hope to start a broader discussion on componentware and to get a common understanding, which open issues are most important in research and industry (as a research agenda).
Java Server Faces
(2004)
Komponenten in J2EE-Patterns
(2002)
Agiles Projektmanagement
(2015)
Das Lehrbuch Software Requirements von Ulrike Hammerschall und Gerd Beneken führt in die Grundkonzepte des Requirements Engineering ein und zeigt anhand vieler anschaulicher Beispiele, wie man systematisch und methodisch bei der Ermittlung, Dokumentation, Spezifikation, Modellierung, Validierung und Verwaltung von Software Requirements vorgeht. Mit seinem Inhalt und didaktisch wertvollem Aufbau richtet sich das Buch an Studierende der Fachrichtung Informatik und Wirtschaftsinformatik, sowie aller verwandten Fachrichtungen, die sich mit den Themen Software Engineering oder Requirements Engineering beschäftigen.
Software Requirements sind die Anforderungen der Anwender an die Funktionalität eines geplanten Software-Systems. Requirements Engineering ist der Prozess zur methodischen Erhebung und Beschreibung der Anforderungen. Die Kunst eines guten Requirements Engineerings ist die Entwicklung einer stabilen Anforderungsbasis als zuverlässige Grundlage für die weitere Entwicklung der Software.
Das vorliegende Buch führt in die Grundkonzepte des Requirements Engineering ein und zeigt anhand vieler Beispiele, wie man systematisch und methodisch bei der Ermittlung, Dokumentation, Spezifikation, Modellierung, Validierung und Verwaltung von Software Requirements vorgeht. Ausführliche Methodenbeschreibungen dienen zur Erläuterung und ein durchgängiges Fallbeispiel hilft dem Leser die Anwendung der Methoden nachzuvollziehen. Mit Hilfe der Übungen am Ende jedes Kapitels, können die Methoden selbst eingeübt werden.
Neben dem klassischen Dokument-getriebenen Requirements Engineering beschäftigt sich das Buch mit den Methoden des agilen Requirements Engineering und vergleicht die beiden Ansätze. Zusätzlich bietet das Buch einen Blick über den Tellerrand und betrachtet die Schnittstellen des Requirements Engineerings zu anderen Teilprozessen im Entwicklungsprozess.
Das Buch richtet sich an Studierende der Fachrichtung Informatik und Wirtschaftsinformatik, sowie aller verwandten Fachrichtungen, die sich mit den Themen Software Engineering oder Requirements Engineering beschäftigen.
- Der RE-Prozess, Vorgehen und Methodik.
- Anforderungsermittlung, -dokumentation und -spezifikation.
- Querschnittliche Aufgaben wie Validierung, Modellierung und Management von Anforderungen
- Agiles RE, Vorgehen und Methodik.
- Schnittstellen zu benachbarten Teilprozessen (Projektmanagement, Qualitätsmanagement, Software-Architektur) sowie zum Usability Engineering.
- Einführung und Verbesserung des Requirements Engineering Prozesses in einer Organisation.
Software-Architektur und Projektmanagement sind Mittel, um große Software-Entwicklungsprojekte beherrschbar zu machen. Die Verbindung zwischen beiden Disziplinen wird in dieser Arbeit mithilfe einer Architekturtheorie hergestellt: Ein Verfahren wird vorgeschlagen, mit dem die Beschreibung der logischen Architektur und die Projektplanung iterativ abgeglichen und verbessert werden können. Verfahren zur architekturbasierten Optimierung der Planung werden daraus entwickelt. Die Dokumentation von Architekturen mithilfe von Architektursichten ist der zweite Schwerpunkt. Mathematisch fundierte Verfahren zur Erzeugung von Sichten werden mithilfe einer Architekturtheorie definiert. Die Verfahren erzeugen etwa Architektursichten, die Projektmanagement und die Kommunikation innerhalb des Projektes mithilfe von Planungsinformationen unterstützen. Ein prototypisches Werkzeug demonstriert Anwendbarkeit der Theorie und der vorgeschlagenen Verfahren
Eines der ersten deutschsprachigen Bücher zum Thema! Marco Kuhrmann / Gerd Beneken Windows® Communication Foundation Konzepte - Programmierung – Migration (copy) Die Windows Communication Foundation ist als Kommunikationsframework Bestandteil von .NET 3.0. Sie stellt die Grundlage für Service-orientierte, Web Service-basierte, verteilte Anwendungen unter Microsoft Windows dar. Dieses Buch gibt Ihnen einen umfassenden Überblick über die neue Plattform. Es führt grundlegende Konzepte ein und stellt einen kompakten Leitfaden für die Softwareentwicklung auf Basis der Windows Communication Foundation dar. Anhand praktischer Beispiele werden Sie durch die Themen Services, Messaging usw. bis hin zu Fragen der Migration geführt.
Mehrstufige Architekturen mit SQLJ und Enterprise JavaBeans Datenbankanbindung und Erstellung von Komponenten sind ein essentieller Bestandteil von Java-Anwendungen. Bei Java-Schnittstellen rückt der neue ANSI-Standard SQLJ für relationale und objektrelationale Datenbanken immer mehr in den Blickpunkt. Bei mehrstufigen Architekturen ist darüber hinaus die Komponentenbildung unabdingbar, und dabei entwickelt sich EJB zu einem De-facto-Standard. Nach einer grundlegenden Einführung geht es im zweiten Teil des Buches um Java-Schnittstellen zu Datenbanken: JDBC, ODMG und SQLJ8. Wie EJB-Komponenten erstellt werden und auf Java-Datenbanken zugreifen, wird im dritten Teil beschrieben.
Referenzarchitekturen
(2006)
Die Architektur eines Software-Systems ist im Wesentlichen die Beschreibung des Systems anhand einzelner Beziehungen, die zwischen diesen Bausteinen bestehen. Die Wahl einer bestimmten Architektur ist eine grundlegende Entscheidung im Entwicklungsprozess und hat großen Einfluss auf die Qualität des späteren Systems. In diesem Handbuch wird erstmalig ein fundierter Einstieg und Überblick über den Stand der Technik und zukunftsweisende Entwicklungen im Bereich der Software-Architekturen gegeben. Ausgehend von der Rolle des Software-Architekten werden die Konstruktion und Evolution sowie Migration von Software-Architekturen systematisch aufbereitet. Als Modellierungssprache wird überwiegend die Unified Modeling Language (UML) verwendet. Um ein umfassendes Verständnis für die Bedeutung von Architekturbeschreibungen zu erhalten, werden auch dieThemen Management, Bewertung und Wiederverwendung von Software-Architekturen behandelt. Ebenso wird auf neuere Konzepte wie Model-Driven Architecture (MDA), Software-Produktlinien, Reverse Engineering sowie Performance- und Sicherheitsaspekte eingegangen. Dabei werden die Konzepte beispielhaft illustriert. Im Anhang befinden sich ein Kapitel über formale Grundlagen der Architekturmodellierung, eine Übersicht über Architekturbeschreibungssprachen sowie ein Glossar. Das Buch ist ein Gemeinschaftswerk der Mitglieder des Arbeitskreises Software-Architektur der Gesellschaft für Informatik
Abstraction is the most basic principle of software engineering. Abstractions are provided by models. Modeling and model transformation constitute the core of model-driven development. Models can be refined and finally be transformed into a technical implementation, i.e., a software system.
The aim of this book is to give an overview of the state of the art in model-driven software development. Achievements are considered from a conceptual point of view in the first part, while the second part describes technical advances and infrastructures. Finally, the third part summarizes experiences gained in actual projects employing model-driven development.
Beydeda, Book and Gruhn put together the results from leading researchers in this area, both from industry and academia. The result is a collection of papers which gives both researchers and graduate students a comprehensive overview of current research issues and industrial forefront practice, as promoted by OMG’s MDA initiative.
Background
A multitude of different rehabilitation interventions and other specific health care services are offered for individuals with disorders of consciousness in long-term care settings. To investigate the association of those services and patient-relevant outcomes, a specific instrument to document the utilization of those services is needed. The purpose of this study was to develop such a questionnaire administered to caregivers in epidemiological studies or patient registries in Germany.
Methods
The development process of the RECAPDOC questionnaire was carried out in three steps. Step 1 consisted of a systematic literature review and an online-based expert survey to define the general content. Step 2 was an expert interview to evaluate the preliminary content of the questionnaire. Step 3 was a pretest including cognitive interviews with caregivers. After each step, the results were combined into a new version of the questionnaire.
Results
The first version of the questionnaire included items on utilization of medical care, medical aids, nursing and therapeutic care. The results of the expert interview led to the integration of five new items and the modification of six other items. The pretest led to some minor modifications of the questionnaire since it was rated as feasible and acceptable. The final questionnaire consisted of 29 items covering the domains “living situation”, “social insurance status”, “utilisation of home health care”, “domestic services”, “outpatient health care”, “specific diagnostic measures”, “adaptive technologies”, “medical aids” and “utilization of therapies”. Also the experience of family support and multidisciplinary collaboration of health professionals is covered.
Conclusions
The developed questionnaire is a first step to make the situation of patients with disorders of consciousness in the long-term care setting accessible for evaluation in epidemiological studies and in the context of patient registries. However, further reliability and validity studies are needed.
Das Buch bietet eine umfassende und praxisorientierte Einführung in die wesentlichen Grundlagen und Konzepte der Informatik. Es umfasst den Stoff, der typischerweise in den ersten Semestern eines Informatikstudiums vermittelt wird, vertieft Zusammenhänge, die darüber hinausgehen und macht sie verständlich. Die Themenauswahl orientiert sich an der langfristigen Relevanz für die praktische Anwendung. Praxisnah und aktuell werden die Inhalte für Studierende der Informatik und verwandter Studiengänge sowie für im Beruf stehende Praktiker vermittelt. Die vorliegende fünfte Auflage wurde grundlegend überarbeitet und aktualisiert.
Background
Joint contractures are frequent in older individuals in geriatric care settings. Even though they are used as indicator of quality of care, there is neither a common standard to describe functioning and disability in patients nor an established standardized assessment to describe and quantify the impact of joint contractures on patients’ functioning. Thus, the aim of our study is (1) to develop a standard set for the assessment of the impact of joint contractures on functioning and social participation in older individuals and (2) to develop and validate a standardized assessment instrument for describing and quantifying the impact of joint contractures on the individuals’ functioning.
Methods
The standard set for joint contractures integrate the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development of this set follows the methodology to develop an International Classification of Functioning Disability and Health (ICF) Core Set and involves a formal decision-making and consensus process. Evidence from four preparatory studies will be integrated including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and a cross sectional study with patients affected by joint contractures. The assessment instrument will be developed using item-response-theory models. The instrument will be validated.
Discussion
The standard set for joint contractures will provide a list of aspects of functioning and health most relevant for older individuals in geriatric care settings with joint contractures. This list will describe body functions, body structures, activities and participation and related environmental factors. This standard set will define what aspects of functioning should be assessed in individuals with joint contractures and will be the basis of the new assessment instrument to evaluate the impact of joint contractures on functioning and social participation.
Objective: To explore whether the concepts important to patients with hand osteoarthritis (OA) are covered by the most commonly used instruments measuring functioning.
Method: A qualitative multicentre study using a focus group technique was performed in five European countries: Austria, The Netherlands, Norway, Sweden and the United Kingdom. The qualitative data analysis followed a modified form of “meaning condensation” and used the International Classification of Functioning, Disability and Health (ICF) as a theoretical framework. Finally, the concepts from the focus groups were compared with the content of the most commonly used instruments which had been identified in an earlier theoretical analysis.
Results: Fifty-six people (51 women, mean (SD) age 62.7 (7.9) years) with hand OA participated in this study in two focus groups per centre. 63 concepts were extracted from the focus groups. Twenty-one (33%) of the 63 concepts were covered by at least one instrument. Psychological consequences, different qualities of pain, aesthetic changes and leisure activities are important concepts from the focus groups which were not covered by the instruments. The qualitative analysis revealed detailed descriptions of pain-concerning sensations, levels and a certain relation to activity, none of which were fully represented in the instruments routinely used.
Conclusion: It was possible to combine the concepts of the focus groups from each centre into a common qualitative analysis. The concepts important to people with hand OA are not fully represented in the most commonly used instruments.
Background Free movement of the limbs is a prerequisite of mobility and autonomy in old age. Joint contractures, i.e. restrictions in full range of motion of any joint due to deformity, disuse or pain, are common problems of frail older people, particularly in nursing home residents.
Contractures are among the most unexplored and underreported syndromes in clinical and homecare settings. Epidemiological studies indicate a wide range of prevalence of joint contractures in older individuals between 20% and 80%. This variation is due to different definitions of contracture and varying diagnostic criteria or data collection methods, different research settings, sample size and study participants? characteristics.
The aetiology of joint contractures is multifaceted. In older people contractures may be caused by a variety of health conditions and situations, but immobility due to an acute injury or disease seems to be the major risk factor. Upper limb joint contractures may result in loss of ability to dress or eat independently while lower limb contractures may lead to instability and inability to walk independently and higher risk of bed confinement.
Joint contractures further increase the risk of other adverse patient outcomes like pain, pressure ulcers and risk of falls. Thus, joint contractures are a major cause for excess disability in older people with a significant impact on overall quality of life and functioning. Preventive and rehabilitation interventions targeting joint contractures may decrease morbidity, increase functioning and quality of life, and, ultimately, prevent long-term disability. In the United States of America, presence of joint contractures is an established indicator of quality of care in nursing facilities.
In Germany, joint contracture risk assessment and prevention have recently been defined as a quality indicator of nursing home care that should be regularly monitored by experts from the statutory health insurance system. Nursing homes are obliged to report whether they regularly assess the risk of joint contracture and administer relevant preventive measures. In clinical settings, joint contractures are assessed by measuring the range of motion.
However, from a patient- and nursing-oriented perspective the relevance of a systematic registration of contractures in care-dependent older people is unclear unless their impact on functioning is understood. Contracture assessment is only an intermediate step in the evaluation of patient-relevant outcomes such as quality of life, functioning, and the ability to participate in everyday life and social participation. Arguably, a clinical definition of joint contracture is difficult because the contracture?s severity is determined by the consequences on activities of daily living, quality of life and social participation. In addition, there is no consensus on aspects most relevant to the affected individuals.
A variety of functional measures is currently used for the assessment and evaluation of geriatric patients. To date, there is no consensus on common concepts for the choice of outcome measures specifically for evaluating the impact of interventions targeted on joint
Aktuare treffen, genauso wie Finanzmathematiker und Risikomanager, jeden Tag Einschätzungen über Risiken. Unter Risiken verstehen sie dabei Objekte, an denen sich zufällige Phänomene realisieren, und die sich somit einer sicheren Einschätzung entziehen.
Dabei bedienen sich die Aktuare stochastischer Risikomodelle, um
Erklärungsmuster für historische Beobachtungen der Risiken zu finden, Zukunftsvorhersagenbezüglich der Risiken zu treffen und die Genauigkeit der getroffenen Einschätzungen und Prognosen zu bewerten. Stochastische Risikomodelle sind mithin ein Instrument, um die Einschätzung von Risiken zu objektivieren.
Risikomodelle werden in der Regel mit statistischen Methoden an Beobachtungsdaten angepasst. Aus einem Modell heraus getroffene Aussagen werden spätestens hierdurch zu Einschätzungen, die – um mit Descartes zu sprechen – lediglich „wahrscheinlich“ korrektsind. Hier kannein stochastisches Modell helfen, die Wahrscheinlichkeit zu quantifizieren, mit der eine gegebene Einschätzung falsch ist, und die Wahl einer geeigneten statistischen Methode zur Modellanpassung kann helfen, diese Wahrscheinlichkeit zu reduzieren.
Stochastische Risikomodelle und statistische Methoden erlauben somit einen wissenschaftlich korrekten Umgang mit dem von Descartes aufgezeigten Dilemma.
Allerdings: Risikomodelle sind künstlich – sie leben von den Annahmen, die ihnen zugrunde liegen. Für eine seriöse Modellbildung ist daher das Verständnis und die Validierung der Modellannahmen unverzichtbar, wie auch ein Überblick über mögliche alternative Modelle. Das vorliegendeBuchmöchte daherdie wichtigsten stochastischen Risikomodelle, die derzeit in der aktuariellen Praxis Anwendung finden,in einem Band zusammenfassen. Dabei wird Wert auf eine mathematisch fundierte,aber dennoch für Theoretiker und Praktiker gut verständliche und interessante Darstellung der Modelle mit ihren Eigenschaften und Annahmen gelegt.
Gleichzeitig werden die statistischen Methoden zur Modellanpassung bereitgestellt.
Die behandelten Modelle und Methoden sind auch die Grundlage, auf denen zahlreiche Anwendungen in Finanzmathematik und quantitativem Risikomanagement aufbauen.
Purpose: The aim of this study was to identify health-relevant aspects of functioning and disability of persons aged 65 years or older with joint contractures, to link the findings to corresponding ICF categories and to describe the patients’ perspective.
Methods: We conducted 43 qualitative, semi-structured, face-to-face interviews with affected persons in two different locations (Witten, Munich) and in three different settings. Data were analyzed using the “meaning condensation procedure” and then linked to ICF categories.
Results: From all interviews a total of 2499 single meaning-concepts were extracted which were linked to 324 different ICF categories. The participants in all settings mainly reported problems related to “Mobility of a single joint (b710)”, “Sensation of pain (b280)” and problems related to “Walking (d450)”. Almost all participants reported “Products and technology for personal indoor and outdoor mobility and transportation (e120)” as a relevant environmental factor. Conclusions: From the patients’ perspective, joint contractures have an impact on multifaceted aspects of functioning and disability, mainly body functions, environmental factors and activities and participation. The results of this study will contribute to the development of a standard instrument for measuring functioning, disability and health-relevant aspects for patients with joint contractures.
Implications for Rehabilitation
Joint contractures are a major cause for the development of disability in older people.
Patients’ perspectives and their personal experiences have to be considered when assessing the impact of joint contractures.
The International Classification of Functioning, Disability and Health (ICF) is an appropriate framework for describing the patients’ multifaceted experience of joint contractures.
Purpose
The aim of this study was to identify disease‐related aspects of functioning and disability in people with joint contractures from a health professionals' perspective and to describe the findings, using categories of the International Classification of Functioning, Disability, and Health (ICF).
Design
An Internet‐based expert survey.
Methods
We asked international health professionals for typical problems in functioning and important contextual factors of individuals with joint contractures using an Internet‐based open‐ended questionnaire. All answers were linked to the ICF according to established rules. Absolute and relative frequencies of the linked ICF categories were reported.
Findings
Eighty experts named 1785 meaning units which could be linked to 256 ICF categories. Among the categories, 24.2% belonged to the component Body Functions, 20.7% to Body Structures, 36.3% to Activities and Participation, and 18.8% to Environmental Factors.
Conclusion
Health professionals addressed a large variety of functional problems and multifaceted aspects due to the symptom joint contractures.
Clinical Relevance
International health professionals reported a large variety of aspects of functioning and health, which are related to joint contractures
Hintergrund und Fragestellung: Bisphosphonate sind eine effektive Therapie der Osteoporose. Unverträglichkeiten, insbesondere gastrointestinale Nebenwirkungen, sind häufig Ursache von Therapieabbrüchen. Ziel der Untersuchung ist, Unterschiede der Adhärenz (Akzeptanz, Persistenz/Therapieabbruch, Compliance) zwischen täglicher (ALD-D) und wöchentlicher (ALD-W) Einnahmefrequenz bei dem Bisphosphonat Alendronat zu untersuchen.
Patienten und Methoden: Die Analyse beruht auf Verschreibungsdaten zweier Zufallsstichproben von jeweils 144 Patientinnen ab einem Alter von 45 Jahren mit täglicher bzw. wöchentlicher Einnahmefrequenz über einen Zeitraum von 12 Monaten ab Initiierung der Therapie. Ein Therapieabbruch war definiert als das Aufbrauchen der letzten Verschreibung. Akzeptanz wurde am Anteil der Patientinnen ohne Therapieabbruch nach der ersten Verschreibung gemessen. Compliance wurde am MPR (Medication possession ratio = prozentualer Anteil der Tage im Jahr, an denen Medikation vorliegt) gemessen. Therapeutisch relevante Compliance, die zur Reduktion von Frakturrisiken führte, war bei einem MPR >80 % gegeben.
Ergebnisse: 31,3 % (ALD-W) vs. 45,8 % (ALD-D) der Patienten brachen die Therapie nach der 1. Verschreibung, 53,5 % (ALD-W) vs. 72,2 % (ALD-D) brachen die Therapie im Verlauf eines Jahres ab. Die Abbrecherrate war unter täglicher Einnahme signifikant höher (p = 0,0035). Die durchschnittliche Dauer bis zum Therapieabbruch inklusive Therapieunterbrechungen betrug 220 Tage (ALD-W) vs. 169 Tage (ALD-D). Die durchschnittliche Compliance aller Patienten betrug 51,7 % (ALD-W) vs. 37,7 % (ALD-D). 30,6 % (ALD-W) vs. 19,2 % (ALD-D) (p = 0,0295) aller Patienten erreichten eine therapeutisch relevante Compliance.
Folgerungen: Eine große Zahl von Patienten brach die Therapie mit Bisphosphonaten ab, viele schon nach der ersten Verschreibung. Die Adhärenz wurde durch die Verringerung der Einnahmefrequenz verbessert, blieb aber suboptimal. Es besteht ein Bedarf für Therapien, die zu besserer Therapietreue führen können.
Am 01. Januar 2011 ist das Gesetz zur Neuordnung des Arzneimittelmarktes (Arzneimittelmarktneuordnungsgesetz, AMNOG) in Kraft getreten. In diesem Rahmen wurde für den Impfstoffmarkt ein Referenzpreissystem eingeführt um die deutschen Impfstoffpreise an das als niedriger vermutete Preisniveau anderer Staaten der europäischen Union (EU) anzupassen. Im Folgenden wird die Umsetzung, die Funktionsweise und die Auswirkungen dieses neuen Systems beschrieben. Des Weiteren wird anhand des Beispiels der Grippeimpfstoffe analysiert, welchen Einfluss die Referenzpreise auf das Preisgefüge haben.
Methodik:
Das Referenzpreissystem wird anhand des Gesetzes zur Neuordnung des Arzneimittelmarktes und des Schreibens des Spitzenverbandes Bund der Krankenkassen (GKV-Spitzenverband, GKV-SV) vom 22. Juni 2011 an die Verbände der Arzneimittelhersteller und Arzneimittelimporteure beschrieben. Der Analyse der Impfstoffpreise liegen die Daten des i:data-Report (Stand: 01. September 2011) des ifap Service-Instituts zugrunde.
Ergebnisse:
Der europäische Referenzpreis eines Impfstoffes wird als Durchschnittspreis aus den tatsächlich gültigen Abgabepreisen des entsprechenden Impfstoffes in den 4 Ländern der europäischen Union, deren Bruttonationaleinkommen dem deutschen am nächsten kommt und in denen der Impfstoff vertrieben wird, berechnet. Die hierzu herangezogenen Preise werden dabei mit den Umsatzanteilen und Kaufkraftparitäten (KKP) für Gesundheitspflege der jeweiligen Länder gewichtet. Die vorliegende Analyse weist darauf hin, dass insbesondere die praktische Umsetzung des Referenzpreissystems weiter verbessert und konkretisiert werden sollte. Zum einen sollte die Berechnung der Referenzpreise durch den GKV-SV so ausgestaltet werden, dass eine Vergleichbarkeit der Preise gewährleistet ist. Außerdem bestehen erhebliche Probleme bei der Abrechnung der Abschläge, da in der Dokumentation der impfenden Ärzte zunächst nicht unterschieden werden konnte, ob eine Impfung als Pflicht- oder Satzungsleistung erbracht wurde. Der Vergleich der Herstellerabgabepreise der einzelnen Grippeimpfstoffe mit den entsprechenden Referenzpreisen zeigt jedoch sowohl bei den Einzelpackungen als auch bei den Zehnerpackungen nach Einführung des Referenzpreissystems eine Vergrößerung der bereits bestehenden Preisunterschiede, die sich im wettbewerblichen System entwickelt haben.
Schlussfolgerung:
Bei der Umsetzung des Referenzpreissystems besteht weiterhin Verbesserungsbedarf. Bei den Grippeimpfstoffen kann voraussichtlich durch das Referenzieren eine Reduktion der Ausgaben für die GKV erreicht werden, allerdings wird das wettbewerbliche Preisniveau verzerrt.
OBJECTIVES: Previous studies have documented the impact of bacteremia involving Methicillin-resistance (MRSA) in patients with Staphylococcus aureus bacteremia, but recent estimates using nationally representative data are not available.
This study compares in-hospital mortality, length of stay (LOS) and total costs between hospital discharges for MRSA and methicillin-susceptible (MSSA) S. aureus bacteremia. METHODS: Using the 2008-2009 Nationwide Inpatient Sample (NIS) data of the Healthcare Cost and Utilization Project, we developed two groups (age18 years): MRSA bacteremia (ICD-9-CM codes: 041.12, V09.0 and 790.7) and MSSA bacteremia (ICD-9-CM codes: 041.11 and 790.7).
Given the skewed distributionofin-hospitalcostsandover-dispersionofLOS,generalizedlinearmodel(GLM) withgammaandnegativebinomialvariancefunctionswereevaluatedtocompare in-hospital costs and LOS, respectively, between groups. Logit model was used to compare in Patient mortality between groups.
Gender,age,payer,11comorbidities, and hospital characteristics, including hospital location, teaching status, bed size, ownership type, and hospital region served as covariates in all regression models.
RESULTS: Patients with MRSA (vs. MSSA) bacteremia were reported as a discharge diagnosis for 0.06% (vs. 0.05%) or 44,157 (vs. 37,653) of all hospital inpatient stays amongadults.
MRSAbacteremiainpatientshadrelativelylongerlengthofhospital stay (12.5 vs. 11.1 days;P0.01), higher total costs ($22,263 vs. $21,330;P0.02), and increased risk of in-hospital death (2.97% vs. 2.71%;P0.29) than inpatients with MSSAbacteremia.
After adjustment for Patient and Hospital characteristics, MRSA bacteremia incurred 10.5% (CI:7.2-14.0%;P0.01) longer stays, 5.6% (CI:2.0-9.4%; P0.01) higher inpatient costs, and 0.3% (CI:17.5-22.0%;P0.97) higher inpatient mortality than MSSA bacteremia. The annual adjusted mean incremental total inpatient cost associated with MRSA was $1,159 (SE: $379;P0.01) per patient-discharge.
CONCLUSIONS:MRSAbacteremiarepresentsaconsiderableattributable burden relative to MSSA bacteremia in the US hospitals. Continued efforts towards preventing MRSA infections would provide significant potential benefits by reducing hospital resource use and costs.
Background: Joint contractures are common problems in frail older people in nursing homes. Irrespective of the exact extent of older individuals in geriatric care settings living with joint contractures, they appear to be a relevant problem. Also, the new emphasis on the syndrome of joint contractures, e. g. by the German statutory long term care insurance, led to an increase in assessment and documentation efforts and preventive interventions in clinical care.
However, more attention should be paid to the actual situation of older individuals in nursing homes with prevalent joint contractures, particularly their experience of related activity limitations and participation restrictions.
Thus, the aim of this study is 1) to develop a tailored intervention to improve functioning, and especially participation and quality of life in older residents with joint contractures in nursing homes and 2) to test the feasibility of the intervention accompanied by a rigorous process evaluation.
Methods: The complex intervention, which will be developed in this project follows the UK Medical Research Council (MRC) framework and integrates the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development process will comprise a systematic literature review, reanalysis of existing data and the integration of the knowledge of the affected individuals and experts.
The developed intervention including a comprehensive process evaluation will be pilot tested with residents with joint contractures in three nursing homes.
Discussion: The projected study will provide a tailored intervention to improve functioning, participation and quality of life in older residents with joint contractures in nursing homes. With this focus, the intervention will support patient relevant outcomes. The pilot study including process evaluation will offer a first opportunity to indicate the size of the intervention’s effect and prepare further studies.
Einen Bund eingehen
(2016)
Background
Joint contractures in nursing home residents limit the capacity to perform daily activities and restrict social participation. The purpose of this study was to develop a complex intervention to improve participation in nursing home residents with joint contractures.
Methods
The development followed the UK Medical Research Council framework using a mixed-methods design with re-analysis of existing interview data using a graphic modelling approach, group discussions with nursing home residents, systematic review of intervention studies, structured 2-day workshop with experts in geriatric, nursing, and rehabilitation, and group discussion with professionals in nursing homes.
Results
Graphic modelling identified restrictions in the use of transportation, walking within buildings, memory functions, and using the hands and arms as the central target points for the intervention. Seven group discussions with 33 residents revealed various aspects related to functioning and disability according the International Classification of Functioning, Disability and Health domains body functions, body structures, activities and participation, environmental factors, and personal factors. The systematic review included 17 studies with 992 participants: 16 randomised controlled trials and one controlled trial. The findings could not demonstrate any evidence in favour of an intervention. The structured 2-day expert workshop resulted in a variety of potential intervention components and implementation strategies. The group discussion with the professionals in nursing homes verified the feasibility of the components and the overall concept. The resulting intervention, Participation Enabling CAre in Nursing (PECAN), will be implemented during a 1-day workshop for nurses, a mentoring approach, and supportive material. The intervention addresses nurses and other staff, residents, their informal caregivers, therapists, and general practitioners.
Conclusions
In view of the absence of any robust evidence, the decision to use mixed methods and to closely involve both health professionals and residents proved to be an appropriate means to develop a complex intervention to improve participation of and quality of life in nursing home residents. We will now evaluate the PECAN intervention for its impact and feasibility in a pilot study in preparation for an evaluation of its effectiveness in a definitive trial.
Trial registration
German clinical trials register, reference number DRKS00010037 (12 February 2016).
Background
Joint contractures are frequent conditions in individuals in geriatric care settings and are associated with activity limitations and participation restrictions. As such, relevant intervention programs should address these aspects, and the effectiveness of such programs should be determined by assessing improvement in activities and participation. However, no patient-centred and psychometrically sound outcome measures for this purpose are available so far.
Objectives
The objectives of this study were to develop and to validate a new outcome measure, the PaArticular Scales, to quantify activities and participation in older individuals with joint contractures. Specific aims were (A) to operationalize the content of an International Classification of Functioning, Disability and Health-based standard set towards meaningful questions and to combine them to a questionnaire and (B) to assess the psychometric properties of the developed questionnaire, in detail to evaluate test–retest reliability, objectivity, internal consistency reliability and criterion validity.
Design
Operationalization was reached by an expert consensus conference and a subsequent expert Delphi survey. Psychometric properties were assessed in a cross-sectional study.
Settings
Nursing homes, geriatric rehabilitation facilities.
Participants
23 experts (nurses, physicians, physical and occupational therapists) participated in the consensus conference and the Delphi survey. A total of 191 individuals with joint contractures (as confirmed by physician, nurse or physical therapist) between 65 and 102 years, living in nursing homes or as patients in geriatric rehabilitation were enrolled in the cross-sectional study.
Methods
Rasch Partial Credit Modelling.
Results
The consensus conference and Delphi survey resulted in a questionnaire with 86 items of the International Classification of Functioning, Disability and Health. Test–retest-reliability among those was acceptable (Cohen's weighted kappa: 0.779). The Rasch analysis revealed two independent interval-scaled scales with 24 items for the Activities scale and 11 items for the Participation scale with high internal consistency reliability. Cronbach's alpha was 0.96 for the Activities scale and 0.92 for the Participation scale. Criterion validity was −0.40 and −0.30 for the Activities scale and for the Participation scale, respectively.
Conclusions
The PaArticular Scales, a new patient-centred and psychometric sound outcome measures to comprehensively assess the impact of joint contractures in geriatric care, are available now. These developed scales will serve as primary outcomes in a scheduled evaluation of a complex intervention to improve participation and quality of life in nursing home residents with joint contractures.
Background: Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference.
Methods: Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories.
Results: From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2 % could be linked to 50 ICF categories in the 2nd level; 3.8 % were not categorised. Fourteen of the 50 categories (28 %) belonged to the component Body Functions, 4 (8 %) to the component Body Structures, 26 (52 %) to the component Activities and Participation, and 6 (12 %) to the component Environmental Factors.
Conclusions: The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact.
Introduction
Joint contractures are characterized as impairment of the physiological movement of joints due to deformity, disuse or pain and have major impact especially for older individuals in geriatric care. Some measures for the assessment of the impact of joint contractures exist. However, there is no consensus on which aspects should constantly be measured. Our objective was to develop a standard-set based on the ICF for describing functioning and disability in older individuals with joint contractures in geriatric care settings, giving special emphasis to activities and participation.
Methods
The ICF-based standard set was developed in a formal decision-making and consensus process and based on an adapted version of the protocol to develop ICF Core Sets. These are sets of categories from the ICF, serving as standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management.
Results
Twenty-three experts from Germany and Switzerland selected 105 categories of the ICF component Activities and Participation for the ICF-based standard set. The largest number of categories was selected from the chapter Mobility (50 categories, 47.6%).
Conclusions
The standard set for older individuals with joint contractures provides health professionals with a standard for describing patients’ activity limitations and participation restrictions. The standard set also provides a common basis for the development of patient-centered measures and intervention programs. The preliminary version of the ICF-based standard set will be tested in subsequent studies with regard to its psychometric properties.
Metric properties of the Spinal Cord Independence Measure - Self Report in a community survey
(2016)
Objective: The Spinal Cord Independence Measure – Self Report (SCIM-SR) is a self-report instrument for assessing functional independence of persons with spinal cord injury. This study examined the internal construct validity and reliability of the SCIM-SR, when administered in a community survey, using the Rasch measurement model.
Methods: Rasch analysis of data from 1,549 individuals with spinal cord injury who completed the SCIM-SR.
Results: In the initial analysis no fit to the Rasch model was achieved. Items were grouped into testlets to accommodate the substantial local dependency. Due to the differential item functioning for lesion level and degree, spinal cord injury-specific sub-group analyses were conducted. Fit to the Rasch model was then achieved for individuals with tetraplegia and complete paraplegia, but not for those with incomplete paraplegia. Comparability of ability estimates across sub-groups was attained by anchoring all sub-groups on a testlet.
Conclusion: The SCIM-SR violates certain assumptions of the Rasch measurement model, as shown by the local dependency and differential item functioning. However, an intermediate solution to achieve fit in 3 out of 4 spinal cord injury sub-groups was found. For the time being, therefore, it advisable to use this approach to compute Rasch-transformed SCIM-SR scores.
Objective: Functioning is an important outcome to measure in cohort studies. Clear and operational outcomes are needed to judge the quality of a cohort study. This paper outlines guiding principles for reporting functioning in cohort studies and addresses some outstanding issues.
Design: Principles of how to standardize reporting of data from a cohort study on functioning, by deriving scores that are most useful for further statistical analysis and reporting, are outlined. The Swiss Spinal Cord Injury Cohort Study Community Survey serves as a case in point to provide a practical application of these principles.
Methods and Results: Development of reporting scores must be conceptually coherent and metrically sound. The International Classification of Functioning, Disability and Health (ICF) can serve as the frame of reference for this, with its categories serving as reference units for reporting. To derive a score for further statistical analysis and reporting, items measuring a single latent trait must be invariant across groups. The Rasch measurement model is well suited to test these assumptions.
Conclusion: Our approach is a valuable guide for researchers and clinicians, as it fosters comparability of data, strengthens the comprehensiveness of scope, and provides invariant, interval-scaled data for further statistical analyses of functioning.
The occupational therapy community has been receptive to the World Health Organisation's International Classification of Functioning, Disability and Health (ICF) published in 2001. Building upon results of a survey (2008–2009) and subsequent workshop (2010) conducted by the World Federation of Occupational Therapists on the use and utility of the ICF for occupational therapists, this paper addresses some of the opportunities and challenges to strengthening the use of the ICF in occupational therapy practice. Attaining further clarity on the relationship of occupational therapy concepts and the ICF and developing crosswalk tables to exemplify linkages between occupational therapy terminology and the ICF will strengthen utility of the ICF for occupational therapy. Enhanced clarity about the concepts within occupational therapy that correspond to the ICF will ultimately assist other professions and disciplines in their understanding about occupational therapy and occupational therapists’ roles in health and related systems.