[Survey of rheumatologists in Saxony, Saxony-Anhalt and Thuringia regarding the occupational situation and activities in further education: no way out of the undersupply of rheumatological care]. / Befragung von Rheumatologen in Sachsen, Sachsen-Anhalt und Thüringen zu Weiterbildungstätigkeit und beruflicher Situation: Kein Ausweg aus der rheumatologischen Unterversorgung.

INTRODUCTION: Many regions in the middle of Germany have a deficit in specialized rheumatological care. A survey was undertaken to investigate whether the regional capacities for rheumatological advanced training are sufficient to provide an adequate number of rheumatologists in the future. METHODS: All 91 rheumatologists registered in Saxony, Saxony-Anhalt and Thuringia received a questionnaire that was sent back by 66% of the recipients (23 responses from Saxony, 19 from Saxony-Anhalt, 18 from Thuringia). Of the rheumatologists 41 were in private practice, 19 worked in an inpatient department and the mean duration of professional activity was 18 years. RESULTS: Over the last decade the number of patients treated by rheumatologists in private practices increased from 1200 to 1500 per quarter year (p < 0.001), whereas the number of first consultations rose from 100 to 130 per quarter year (p = 0.06). The waiting time for a first consultation rose from 8 to 11 weeks (p = 0.01), 32% of the responders indicated that the conditions for outpatient treatment had either improved or had remained constant during the last 10 years, whereas 60% reported a mild or marked deterioration and 48% stated that the number of rheumatologists had decreased within the same time frame. Only 20% indicated that they had a definite successor in the practice after retirement. All inpatient departments also had an outpatient office. During the last 10 years, the number of consultations per quarter year decreased from 1100 to 700 (not significant), while the waiting time doubled from 6 to 12 weeks (rounded mean). Of the rheumatologists in private practice eight are currently entitled to provide advanced education in rheumatology, with a median training period of 18 months; however, none of the responding physicians had actually brought assistant doctors to the final examination during the last decade and only one prospective rheumatologist was currently completing training in a private practice setting. Only 6 out of 12 inpatient rheumatological facilities are entitled to educate rheumatologists over the whole training period, 5 facilities were not involved in training at all and 7 indicated that they lacked applications for rheumatology training. During the last 10 years, 37 rheumatologists completed the training of which 18 went into private practice, 8 worked as general practitioners and 29 remained in the region of their initial training. CONCLUSION: Given the increase in the number of outpatients served, the volume of training activities in rheumatology is hardly sufficient to improve the deficit of rheumatological care in the middle of Germany.

[Providing knowledge and support for caring relatives with the smartphone - the MoCaB project]. / Über das Smartphone Wissen und Unterstützung für pflegende Angehörige bereitstellen.

Providing knowledge and support for caring relatives with the smartphone - the MoCaB project Abstract. Background: Caring relatives often have a lack of knowledge of illness and care options. Surveys, as part of the MoCaB (Mobile Care Backup) project, showed that this is often experienced as a burden. Aim: The aim is to support caring relatives by increasing their knowledge. Therefore care-relevant knowledge and instructions for self-care should be provided according to their needs. Methods: The core element of the mobile application, personalized knowledge transfer in dialogue form, will be developed in a participative process with potential users. The relevant evidence-based nursing knowledge was reviewed by experts and written down for the target group. Results: So far, 86 relevant topics have been identified and formulated. First usability tests showed that the content itself, the used expressions and the presentation via the MoCaB app are well received. Outlook: In a next step, the app will be tested in the home setting with caring relatives and, in order to identify any further need and areas for improvement.

Budding yeast greatwall and endosulfines control activity and spatial regulation of PP2A(Cdc55) for timely mitotic progression.

Entry into mitosis is triggered by cyclinB/Cdk1, whose activity is abruptly raised by a positive feedback loop. The Greatwall kinase phosphorylates proteins of the endosulfine family and allows them to bind and inhibit the main Cdk1-counteracting PP2A-B55 phosphatase, thereby promoting mitotic entry. In contrast to most eukaryotic systems, Cdc14 is the main Cdk1-antagonizing phosphatase in budding yeast, while the PP2A(Cdc55) phosphatase promotes, instead of preventing, mitotic entry by participating to the positive feedback loop of Cdk1 activation. Here we show that budding yeast endosulfines (Igo1 and Igo2) bind to PP2A(Cdc55) in a cell cycle-regulated manner upon Greatwall (Rim15)-dependent phosphorylation. Phosphorylated Igo1 inhibits PP2A(Cdc55) activity in vitro and induces mitotic entry in Xenopus egg extracts, indicating that it bears a conserved PP2A-binding and -inhibitory activity. Surprisingly, deletion of IGO1 and IGO2 in yeast cells leads to a decrease in PP2A phosphatase activity, suggesting that endosulfines act also as positive regulators of PP2A in yeast. Consistently, RIM15 and IGO1/2 promote, like PP2A(Cdc55), timely entry into mitosis under temperature-stress, owing to the accumulation of Tyr-phosphorylated Cdk1. In addition, they contribute to the nuclear export of PP2A(Cdc55), which has recently been proposed to promote mitotic entry. Altogether, our data indicate that Igo proteins participate in the positive feedback loop for Cdk1 activation. We conclude that Greatwall, endosulfines, and PP2A are part of a regulatory module that has been conserved during evolution irrespective of PP2A function in the control of mitosis. However, this conserved module is adapted to account for differences in the regulation of mitotic entry in different organisms.

M-Track: detecting short-lived protein-protein interactions in vivo.

We developed a protein-proximity assay in yeast based on fusing a histone lysine methyltransferase onto a bait and its substrate onto a prey. Upon binding, the prey is stably methylated and detected by methylation-specific antibodies. We applied this approach to detect varying interaction affinities among proteins in a mitogen-activated protein kinase pathway and to detect short-lived interactions between protein phosphatase 2A and its substrates that have so far escaped direct detection.

[What support does a mobile, assistive app provide for informal caregivers? A qualitative analysis of the MoCaB app user experience]. / Unterstützung pflegender Angehöriger durch eine mobile, assistive App. Eine qualitative Analyse der Perspektive von Nutzerinnen und Nutzern der App MoCaB.

BACKGROUND: In the joint project "Mobile Care Backup" funded by the German Federal Ministry of Education and Research, the smartphone-based app "MoCaB" was developed in close cooperation with informal caregivers. It provides individualized, algorithm-based information and can accompany and support caring relatives in everyday life. After a multi-step development, informal caregivers tested the MoCaB app in a home setting at the end of the research project. The goal was to find out how the test persons evaluate MoCaB and in which form the app can provide support to informal caregivers. METHODS: Eighteen test persons caring for relatives participated in a four-week test of MoCaB. Guideline-based qualitative interviews to record usage behavior and experiences with the app were conducted after two and four weeks of testing, transcribed and analyzed using qualitative content analysis. RESULTS: The test persons described the care-related information as helpful. The individualized, algorithm-based mode of information delivery and the exercises provided for family caregivers were generally rated as helpful, but their use depends on the individual usage style. Three dimensions can describe the effects of MoCaB: 1) expansion of care-relevant knowledge, 2) stimulation of self-reflection, and 3) behavior towards the care recipients. DISCUSSION: With few exceptions, the testing caregivers felt that the MoCaB app was enriching. The support dimensions have an effect at different points in everyday life and vary in intensity, depending on the duration of the existing care activity and the individual preferences of the users. CONCLUSION: The way in which caregivers used the app was not always consistent with the expected behaviors. This demonstrates the relevance of open-ended, qualitative research methods in the evaluation of health apps.

An internet based learning tool in orthopaedic surgery: preliminary experiences and results.

Today universities can offer a variety of educational resources to their students through the internet. These may include lecture notes, PowerPoint presentations, or even an entire recording of a lecture in video format. At the Hannover Medical School (Hannover, Germany), the Trauma Surgery Department in collaboration with the Institute of Medical Informatics has developed an alternative method of "E-learning". We created a web-based multimedia resource center for Trauma Surgery using the Content-Management-System (CMS) Schoolbook application, which was initially developed by the Institute of Medical Informatics. The so called "Trauma Surgery Schoolbook" was first adopted in October of 2005 and has since been used and evaluated by medical students at our institution. The evaluation results for the academic year 2005/06 are reported in this paper. The majority of students enrolled in the Trauma Surgery rotation utilized the Schoolbook, which they regarded as a helpful and effective study tool. Our students embraced the possibility of being able to prepare for lectures and use the Schoolbook for independent home studying purposes. Over time, there was a steady increase in the utilization of the Schoolbook by the students from 67% in the first trimester to 93% in the third trimester. The majority of the surveyed students (79.6%) found the Schoolbook to be constructive and helpful. 8.1% did not have any opinion, and only 12.3% found it to not be helpful. The instructors also found this web-based training program to be both constructive and practical, and were able to utilize its multimedia components to complement their lectures. Overall, our experience with this computer-aided learning program demonstrated that web-based technologies can improve the quality of medical education, benefiting both the students and the instructors.

Extending a Knowledge-Based System with Learning Capacity.

Informal caregivers often complain about missing knowledge. A knowledge-based personalized educational system is developed, which provides caregiving relatives with the information needed. Yet, evaluation against domain experts indicated, that parts of the knowledge-base are incorrect. To overcome these problems the system can be extended by a learning capacity and then be trained further utilizing feedback from real informal caregivers. To extend the existing system an artificial neural network was trained to represent a large part of the knowledge-based approach. This paper describes the found artificial neural network's structure and the training process. The found neural network structure is not deep but very wide. The training terminated after 374.700 epochs with a mean squared error of 7.731 ∗ 10-8 for the end validation set. The neural network represents the parts of the knowledge-based approach and can now be retrained with user feedback, which will be collected during a system test in April and May 2019.

Evaluating the Validity of a Knowledge-Based System for Proactive Knowledge Transfer for Caregiving Relatives.

The evaluation of the validity of a knowledge-based system is of great importance during its development. It determines whether the system represents the experts' knowledge correctly. This is highly important, but also particularly difficult, if the expert knowledge is not explicit, but only implicit and tacit. In the following the validity's evaluation of a system for education of caregiving relatives is presented. To evaluate the system's knowledge delivery strategy against the experts' opinion, several fictious characters were created. The evaluation revealed inconsistencies in the knowledge base. After resolving these, the experts' opinion is represented to a large extent by the system. Nevertheless, the used evaluation approach is not capable of detecting all inconsistencies. Therefore, a strong need of a system's learning capacity to integrate feedback from a larger group of real caregiving relatives exists. In addition, a rule-based component, representing disease specific knowledge, should be implemented.

Personalized Knowledge Transfer for Caregiving Relatives.

Caregiving relatives have to manage very diverse tasks and need a lot of care-relevant knowledge. For most of them it is not easy to find the knowledge required. Thus, a personalized knowledge transfer for caregiving relatives is necessary. Against this background, methods to determine the personal relevance and importance of knowledge resources for caregiving relatives are developed. To evaluate these methods, an exemplary fictitious person is created by experts in Nursing Science. In this evaluation, the approach's results are compared with an expert opinion. The approach indicates that a personalized knowledge transfer is possible, providing caregiving relatives with necessary care knowledge according to their personal life situation.

Knowledge Transfer in Health Care Through Digitally Collecting Learning Experiences - Results of Witra Care.

INTRODUCTION: The goal of the project Witra Care was to investigate how far the use of mobile technology is suitable to collect experience-based knowledge of nurses. METHODS: Nine new employees and seven experienced nurses received for six weeks a mobile phone or a tablet pc with a mobile application that allowed them to collect learning object as pictures, videos, audio files or notes. RESULTS: In Witra Care the nurses created 303 learning objects. They have found the collecting of learning experiences was helpful for their learning processes. The learning objects demonstrate various aspects of daily routines in nursing. DISCUSSION: The results of Witra Care show that the documentation of learning experiences with mobile devices helps to gather information about the practical knowledge in the daily work of nurses, identifies individual learning needs of the employees and supports them in their personal learning processes.

Use and Acceptance of Mobile Technology by Hospital Nurses in Germany.

INTRODUCTION: The aim of the study was to measure and describe user behavior, information and communication technology (ICT) competence and technology acceptance of hospital nurses. METHODS: 36 nurses received for six weeks a mobile phone or a tablet pc with mobile application and answered one questionnaire before and after the six weeks. RESULTS: The participating nurses show a high technology acceptance and private daily use of technologies. Younger participants judge their ICT competency higher than older nurses. The perceived ease of use is significantly higher in younger participants. The perceived usefulness was evaluated heterogeneously. DISCUSSION: Despite the barriers mobile technology is perceived as useful for nurses in their daily work. Factors influencing personal, institutional and device acceptance were determined in this study and can be helpful to facilitate the process of implementation of mobile technology.

Using ICT to Support Individual Guidance in Health Promotion Programs for Increased Physical Activity.

INTRODUCTION: We report on experiences in implementing a system to support the individual guidance of training in health promotion programs aiming to increase participants' regular level of physical activity. METHODS: We used an iterative development approach considering data privacy and security aspects, followed by a phase of field testing and continuous further development. RESULTS: Our preliminary results comprise identified clinically relevant parameters, suitable data collection methods, experienced privacy and security challenges and a glance on our developed prototype system. DISCUSSION: We consider our results to be of interest for others doing related research. The most important requirements for a simple supporting system can be fulfilled with established solutions in the short run. A more adaptable and flexible system with an increased level of support in analysing the data, which we aim to achieve, leads to currently open research challenges.

Developing a mobile application for recording learning experiences in nursing practice.

OBJECTIVE: In complex clinical on-the-job training a seamless and target-oriented incorporation is crucial to assure a good medical care. The reliable transmission of specific and relevant facts, besides education knowledge, is a key factor to ensure sustainable quality in care processes. MATERIALS AND METHODS: We present the clinical field study WITRA care. A possible way to capture hidden clinical care knowledge with assistance of mobile devices will be described. RESULTS: Basic functions to collect learning experiences with mobile devices as well as a secure and confidential manner to support a reliable transmission procedure in the hospital network area are implemented. A user experience questionnaire and a semi-standardized interview illustrate first positive acceptance evaluations and time-saving effects. DISCUSSION AND CONCLUSION: With mobile devices, tacit knowledge gaps can be tapped in a clinical care unit. The study provided first insights and proved its feasibility in general. However, advanced problems and questions arose and will be considered in the future.

Transferring learning to practice with e-learning--experiences in continuing education in the field of ambient assisted living.

The article describes an analysis of the use of e-learning to improve the learning transfer to practice in continuing education. Therefore an e-learning offer has been developed as a part between two attendance periods of a training course in the field of Ambient Assisted Living (AAL). All participants of the course were free to use the e-learning offer. After the end of the e-learning part we compared the e-learning users to the other participants. Using an online questionnaire we explored if there are differences in the activities in the field AAL after the training course. The results show that e-learning is beneficial especially for communication processes. Due to the fact that the possibility to talk about the learning content is an essential factor for the learning transfer, e-learning can improve the learning success.

Introduction of e-learning in dental radiology reveals significantly improved results in final examination.

PURPOSE: Because a traditionally instructed dental radiology lecture course is very time-consuming and labour-intensive, online courseware, including an interactive-learning module, was implemented to support the lectures. The purpose of this study was to evaluate the perceptions of students who have worked with web-based courseware as well as the effect on their results in final examinations. MATERIALS AND METHODS: Users (n(3+4)=138) had access to the e-program from any networked computer at any time. Two groups (n(3)=71, n(4)=67) had to pass a final exam after using the e-course. Results were compared with two groups (n(1)=42, n(2)=48) who had studied the same content by attending traditional lectures. In addition a survey of the students was statistically evaluated. RESULTS: Most of the respondents reported a positive attitude towards e-learning and would have appreciated more access to computer-assisted instruction. Two years after initiating the e-course the failure rate in the final examination dropped significantly, from 40% to less than 2%. CONCLUSIONS: The very positive response to the e-program and improved test scores demonstrated the effectiveness of our e-course as a learning aid. Interactive modules in step with clinical practice provided learning that is not achieved by traditional teaching methods alone. To what extent staff savings are possible is part of a further study.

Investigating the post-stimulus undershoot of the BOLD signal--a simultaneous fMRI and fNIRS study.

Measuring the hemodynamic response with functional magnetic resonance imaging (fMRI) together with functional near-infrared spectroscopy (fNIRS) may overcome limitations of single-method approaches. Accordingly, we measured the event-related hemodynamic response with both imaging methods simultaneously in young subjects during visual stimulation. An intertrial interval of 60 s was chosen to include the prolonged post-stimulus undershoot of the blood oxygenation level dependent (BOLD) signal. During visual stimulation, the BOLD signal, oxy-, and total hemoglobin (Hb) increased, whereas deoxy-Hb decreased. The post-stimulus period was characterized by an undershoot of the BOLD signal, oxy-Hb, and an overshoot of deoxy-Hb. Total Hb as measured by fNIRS returned to baseline immediately after the end of stimulation. Results suggest that the post-stimulus events as measured by fNIRS are dominated by a prolonged high-level oxygen consumption in the microvasculature. The contribution of a delayed return of blood volume to the BOLD post-stimulus undershoot in post-capillary veins as suggested by the Balloon and Windkessel models remains ambiguous. Temporal changes in the BOLD signal were highly correlated with deoxy-Hb, with lower correlation values for oxy- and total Hb. Furthermore, data show that fNIRS covers the outer 1 cm of the brain cortex. These results were confirmed by simultaneous fMRI/fNIRS measurements during rest. In conclusion, multimodal imaging approaches may contribute to the understanding of neurovascular coupling.

Near-infrared spectroscopy can detect brain activity during a color-word matching Stroop task in an event-related design.

Brain activity can be monitored non-invasively by near-infrared spectroscopy (NIRS), which has several advantages in comparison with other imaging methods, such as flexibility, portability, low cost and biochemical specificity. Moreover, patients and children can be repetitively examined. Therefore, the objective of the study was to test the feasibility of NIRS for the event-related approach in functional brain activation studies with cognitive paradigms. Thus, changes in the concentration of oxy-, deoxy-, and total hemoglobin were measured by NIRS in 14 healthy subjects while performing a color-word matching Stroop task in an event-related design. The hemodynamic response (increase in the concentration of oxy-/total hemoglobin and decrease in the concentration of deoxy-hemoglobin) was stronger during incongruent compared to congruent and neutral trials of the Stroop task in the lateral prefrontal cortex bilaterally. This stronger hemodynamic response was interpreted as a stronger brain activation during incongruent trials of the Stroop task, due to interference. A new method for NIRS data evaluation that enables the analysis of the hemodynamic response to each single trial is introduced. Each hemodynamic response was characterized by the parameters gain, lag and dispersion of a Gaussian function fitted by nonlinear regression. Specific differences between the incongruent and neutral condition were found for gain and lag. Further, these parameters were correlated with the behavioral performance. In conclusion, brain activity may be studied by NIRS using cognitive stimuli in an event-related design. Hum. Brain Mapping 17:61-71, 2002.