Search

Older people are marginalized in different ways. Examples include social exclusion and stereotypes such as “the lonely and technologically incompetent elderly”. But in the digital age, opportunities for digital empowerment exist alongside marginalization problems: Innovative technical research and development projects are exploring whether and how robots and avatars can help promote social connectedness and inclusion among older people. One of such initiatives is the CO-HUMANICS project. This paper presents the results of an interview study with women and men over 60 years of age. Older people showed heterogeneous attitudes towards robotic-assisted and avatar-assisted interpersonal communication as it will be enabled by the technology developed in the CO-HUMANICS project. [ABSTRACT FROM AUTHOR]

Introduction: This quantitative study investigates the connection between client satisfaction and occupational therapy interventions in a psychosocial rehabilitation in Austria. These interventions had been subject to change, from a handicraft focus, to interventions which also include aspects of everyday life. Method: From May to July 2017, 127 clients answered a written questionnaire about the occupational therapy offered and their satisfaction with this service. Results were analysed with SPSS 25 (level of significance a<0.05). Non-parametric tests such as the Spearman-Brown rank correlation and cross-tabulations were applied. Results: Client satisfaction increased significantly in 2017 compared to 2014. As in the 2014 survey, three therapy-related factors have a positive impact on satisfaction: when clients reported they were working on goals, benefiting from reflection sessions and gaining experience. According to the 2017 survey after the change, the socio-demographic factors age, gender, occupation/unemployment and education level have no significant influence on client satisfaction. Except for the educational level factor, these results also correspond to the 2014 survey before the change. Conclusion: Changing occupational therapy to everyday orientation, all clients can be reached equally well, regardless of socio-demographic factors, and satisfaction can be increased. Presumably, this is due to an intensified focus on everyday life, and due to the possibility to individualise interventions. [ABSTRACT FROM AUTHOR]

Background: Allogeneic blood transfusion is avoidable in many oncological interventions by the use of cell salvage or mechanical autotransfusion (MAT). As irradiation is elaborate and expensive, the safety of leucocyte depletion filters (LDF) for autologous blood from the surgical field might be a more acceptable alternative for the prevention of cancer recurrences. A previous meta-analysis could not identify an increased risk of cancer recurrence. The aim of this review article is to provide an update of a previous meta-analysis from 2012 as well as a safety analysis of cell salvage with LDF due to the improved data situation.Material and Methods: This systematic review included all studies in PubMed, Cochrane, Cochrane Reviews and Web of Science on cell salvage or autotransfusion combined with outcomes, e.g. cancer recurrence, mortality, survival, blood transfusion, length of hospital stay (LOS) after the use of MAT without irradiation and with or without LDF. The grades of recommendations (GRADE) assessment of underlying evidence was applied.Results: A total of seven new observational studies and seven meta-analyses were found that compared unfiltered or filtered cell salvage with autologous predeposition, allogeneic transfusion or without any transfusion. No randomized controlled trials have been completed. A total of 27 observational and cohort studies were included in a meta-analysis. The evidence level was low. The risk of cancer recurrence in recipients of autologous salvaged blood with or without LDF was reduced (odds ratio, OR 0.71, 95% confidence interval, CI 0.58-0.86) as compared to non-transfused subjects, allogeneic or predeposited autologous transfusion. The transfusion rate could not be assessed due to the substantial selection bias and large heterogeneity. Cell salvage does not change mortality and LOS. Leucocyte depletion studies reported a removal rate of cancer cells in the range of 99.6-99.9%.Conclusion: Randomized controlled trials on a comparison of MAT and allogeneic blood transfusion as well as LDF and irradiation would be desirable but are not available. From observational trials and more than 6300 subjects and various tumors, cell salvage in cancer surgery with or without LDF appears to be sufficiently safe. The efficacy of leucocyte depletion of autologous salvaged blood is equivalent to irradiation. Unavailability of radiation is not a contraindication for cell salvage use in cancer surgery. By usage of leucocyte depleted salvaged autologous blood, the risks of allogeneic transfusion can be avoided. [ABSTRACT FROM AUTHOR]

In 1985 Mallampati et al. published a non-invasive score for the evaluation of airways (Mallampati grading scale, MGS), which originally consisted of only three different classes and has been modified several times. At present it is mostly used in the version of Samsoon and Young consisting of four different classes. Class I: soft palate, fauces, uvula, palatopharyngeal arch visible, class II: soft palate, fauces, uvula visible, class III: soft palate, base of the uvula visible and class IV: soft palate not visible. Nevertheless, other versions of MGS still exist, each having different values for sensitivity and specification. The current opinion is therefore that MGS is no longer useful as a stand-alone predictor but in combination with others it is still part of today's most relevant guidelines, such as those of the American Society of Anesthesiologists (ASA), the UK's Difficult Airway Society (DAS), the European Society of Anaesthesiology (ESA) and the German Society for Anesthesiology and Intensive Care Medicine (DGAI) and must therefore be known by anesthetists. Even in times of sophisticated tools for airway management, the procedure remains a high risk, so every anesthetist has to be prepared for and well trained in management of known and unexpected difficult airways. Evaluation of the patient's airway is a part of modern airway management to prevent problems and reduce risk of hypoxia during the procedure. The theoretical knowledge and practical skills of European anesthetists were evaluated at two international congresses, the German Anesthesia Congress (DAC) and Euroanaesthesia 2014. The DAC is an annual meeting of German speaking anesthetists, hosted by the DGAI. The Euroanaesthesia is the annual European pendant hosted by the ESA. Participation was voluntary and only physicians were allowed to take part. Theory was evaluated by a questionnaire containing open and closed questions for MGS that had to be answered by every participant alone. Apart from theory, a practical evaluation was performed. Every participant had to classify the MGS of a human airway model. The model was identical on both congresses. According to the original publication a checklist containing the factors essential for the correct performance was filled out by a supervising experienced anesthetist. During DAC 2014 n = 267 physicians participated in the study, 22 participants were excluded due to inconsistent answers, incomplete questionnaires or missing practical part. A total of 245 data sets were evaluated. During Euroanaesthesia 2014 n = 298 physicians participated in the study, 68 participants were excluded due to inconsistent answers, incomplete questionnaires or missing practical part and 230 data sets were evaluated. At the DAC the mean age (± SD) was 44.5 ± 9.5 years, 157 (64.1%) were male and 88 (35.9%) were female. Working experience was trainee anesthetist in 16.7% and other participants were experienced anesthetists. At the ESA the mean age (± SD) was 42.4 ± 9.5 years, 133 (57.8%) were male and 97 (42.2%) female. Trainee anesthetists were 15.2%, the rest were experienced anesthetists. The DAC participants knew Mallampati classes 1 (65%) and 4 (45%) better than 2 and 3 and there was no relevant differences to the ESA (close to 30% knew the classes 1-4 here). Classification of the airway model was correct in 62% and 67% at DAC and ESA, respectively. Most participants performed the practical evaluation correctly except the sitting position of the model. In agreement with earlier studies, these results show the lack of knowledge in evaluation of airways according to current guidelines of all relevant societies. This is likely to increase preventable risks for patients as unexpected difficult airway management increases the risk for hypoxia and intubation damage. [ABSTRACT FROM AUTHOR]

Background: Mask ventilation could improve after administration of muscle relaxants if there is a functional obstruction of the airway, such as laryngospasm, vocal cord closure or opioid-induced muscle rigidity. On the other hand, muscle relaxants could worsen mask ventilation because they induce upper airway collapse; however, clinical studies showed that rocuronium (Roc) improved mask ventilation or it remained unchanged. In most cases Roc 0.06 mg/kgBW was used.Objective: The optimal dose of Roc has not been studied; therefore, we studied the quality of mask ventilation with three different doses of Roc (0.3, 0.6 and 0.9 mg/kgBW) and compared them with a control group receiving saline.Material and Methods: In this prospective clinical trial 200 patients were randomized into 4 groups: NaCl (saline), Roc03 (Roc 0.3 mg/kgBW), Roc06 (Roc 0.6 mg/kgBW) and Roc09 (Roc 0.9 mg/kgBW). Mask ventilation was performed to reach a tidal volume (TV) of >5.0 ml/kgBW; maximum ventilation peak pressure (ppeak) was limited to 25 mbar. If this TV was not reached, mask ventilation was improved by better mask position, head position or/and usage of a Guedel tube (oropharyngeal airway). During mask ventilation ppeak and TV were recorded and the quality of mask ventilation was assessed with the Han and Warters scores. The quality of mask ventilation between the four groups was compared for all patients and a subgroup analysis was performed for patients of the study groups, who had to be ventilated with a Guedel tube and for obese patients (body mass index ≥26 kg/m2). A sample size calculation revealed that at least 38 patients were necessary for each group to detect a statistically significant difference between groups; it was assumed that Roc improved the efficacy of mask ventilation by 20% compared to saline (α = 0.05, 1-β = 0.8).Results: The administration of Roc significantly improved the TV/ppeak ratio compared to saline (p = 0.04); however, this effect was irrespective of the dose. In patients who were ventilated with the Guedel tube the TV/ppeak ratio increased after Roc03 (p ≤ 0.01) and after Roc06 (p < 0.02) compared to the saline group. In obese patients who were ventilated with the Guedel tube the TV/ppeak ratio increased after Roc03 (p ≤ 0.01), after Roc06 (p = 0.03) and after Roc09 (p = 0.02) compared to the saline group. There were no significant differences between the Roc groups; however, the effect was more pronounced in the Roc03 patients compared to the other Roc groups. The Han and Warters scores were not significantly different between the Roc groups and the saline group.Conclusion: The efficacy of mask ventilation was equal or improved after administration of Roc but did not become worse. Patients who were ventilated with a Guedel tube had higher TV/ppeak ratios after Roc03 and Roc06 compared to saline. Higher dosages (>Roc06), however, had no advantages concerning quality of mask ventilation. In obese patients who had to be ventilated with a Guedel tube, Roc also improved the efficacy of mask ventilation. We conclude that administration of Roc is effective in improving mask ventilation and this effect was seen after 30-60 s even after Roc03. [ABSTRACT FROM AUTHOR]

Background: Palliative sedation (PS) serves as a therapeutic option in cases of otherwise intractable suffering. As the use of sedative and hypnotic medication in many diverse situations is a core competency of anesthesiology, anesthesiologists are confronted with questions of sedative therapy at the end of life in institutions for specialized palliative care, in intensive care units and intermediate care wards. In recent years a number of guidelines have been published internationally but so far no official guidelines exist in Germany. The most recognized document is the European Association for Palliative Care (EAPC) framework on PS. This project aims to develop a German language template for the preparation, application, documentation and evaluation of PS according to the current frameworks, especially the EAPC framework on PS.Methods: A first draft of the template was generated by the project team using the EAPC framework and individual templates of various institutions, which had been collected during a previous project. Professionals (n = 136) from inpatient and outpatient specialist palliative and hospice care were invited to assess all items of the draft regarding "relevance", "wording" and "feasibility" in an online Delphi survey (Unipark®, Questback, Cologne, Germany). After the second Delphi round an expert panel was asked to reflect the results and generate a final draft. Approval was granted if acceptance exceeded 75% of participants.Results: The 3 rounds of the Delphi process were completed by 64, 46 and 41 participants, respectively. The Delphi process as well as the expert panel led to significant changes of the template. The indications for PS had to be clarified. The significance of documentation of vital parameters, such as oxygen saturation, blood pressure or respiratory rate during PS was intensively discussed. In many teams, predominantly hospice or outpatient palliative care teams, it seems to be difficult to measure these parameters or it is regarded as inappropriate in a palliative care setting. In contrast, the EAPC framework recommends monitoring of vital parameters in cases of intermittent or respite sedation. Finally, a solution was found to support documentation of additional data without the explicit mentioning of specific parameters. After the third Delphi round, all 16 items of the documentation template reached consensus with respect to relevance (82.9-100%), clarity of wording (80.5-100%), and feasibility in practice (78-100%).Conclusion: This article provides an empirically based, multiprofessional consented documentation template for PS. Core elements of the documentation of PS are the indications and the decision process towards PS. During the treatment, at least the level of sedation and the symptom burden have to be recorded. The documentation of vital signs during PS remains a highly disputed topic. The presented data suggest that especially in outpatient settings and in hospices measuring and documentation of vital parameters is uncommon and therefore is often regarded as not feasible. This template can help to support the medically and ethically sound use of PS and facilitate research. The template can be accessed at http://www.palliativmedizin.uk-erlangen.de/forschung/downloads/ . [ABSTRACT FROM AUTHOR]

Background: Antipyretics are among the most widely prescribed drugs in German hospitals. Despite this widespread use, their role for treatment of critically ill patients still remains unclear. In particular, the questionable positive effects of reducing fever are discussed.Objectives: In this review we aimed to summarize and discuss current study results covering the use of antipyretics in critically ill patients. Suspected effects with regard to fever reduction and lethality should be considered.Materials and Methods: A selective literature search was carried out in the PubMed database. We reviewed the bibliographies of all work considered relevant.Results: There are only a few studies on the use of antipyretics in intensive care patients, which are difficult to compare systematically due to different designs, protocols and endpoints. All in all, the decrease in temperature was very low (0.3 °C) and showed even adverse effects on 28-days mortality in sepsis. In patients with sepsis and ASS medication, a decreased mortality has been shown in retrospective analysis.Conclusions: The benefit of fever control using antipyretics in intensive care patients with regard to endpoints like lethality remains unclear. Randomized controlled trials with suitable protocols and endpoints are needed to provide a solid base for development of guidelines. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether health related quality of life measured in German patients one year after mechanical ventilation in the intensive care unit is impaired or not.Objectives: The aim of this study was to assess health related quality of life one year after inclusion into a randomized controlled trial for weaning from mechanical ventilation with the help of a questionnaire that has never been used in critically ill patients and to investigate whether health related quality of life scores differ between the study population and a general German population.Methods: We followed up with patients one year after inclusion into a randomized control trial investigating the effect of SmartCare/PS on total ventilation time compared to protocol-driven weaning (ASOPI trial, clinicaltrials.gov ID00445289). Health related quality of life was measured using the quality of life questionnaire C‑30 version 3.0 from the European Organization of Research and Treatment of Cancer (EORTC). Mean differences of at least 10 score points in the quality of life scales were considered clinically significant.Results: Of the 232 patients who were alive 90 days after study inclusion, 24 patients died one year after study inclusion and 64 patients were lost to follow-up. Of the remaining145 patients who were successfully contacted, 126 patients agreed to fill out the questionnaire. Questionnaires were sent back to the study site by 83 patients and these were analyzed. Health-related quality of life was significantly lower in five of the six functional scales (physical functioning, role functioning, cognitive functioning, social functioning, global health status) and in eight of the nine symptom scales (fatigue, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, financial difficulties) compared to the reference values of a German normal population.Conclusions: The EORTC QLQ-C30 questionnaire is suitable for the acquisition of the health-related quality of life in formerly critically ill patients. Health-related quality of life is severely impaired after mechanical ventilation in the intensive care unit. Future studies should consider health related quality of life as a possible study endpoint. [ABSTRACT FROM AUTHOR]

Background: Ultrasound guided distal sciatic nerve block (DSB) at bifurcation level shows fast onset and provides excellent success rates. However, its safe performance might be difficult for the unexperienced physician. Just slightly distal to the bifurcation, the tibial nerve (TN) and common fibular nerve (CFN) can be shown clearly separated from each other. Therefore, we investigated if a block done here would provide similar quality results compared to the DSB proximally to the division, with a potentially lower risk of nerve damage.Methods: In this randomized, prospective trial, 56 patients per group received either a DSB distal to the bifurcation "out-of-plane" (dist.) or proximally "in-plane" (prox.) with 30 ml of Mepivacaine 1% each. Success was tested by a blinded examiner after 15 and 30 min respectively (sensory and motor block of TN and CFN: 0 = none, 2 = complete, change of skin temperature). Videos of the blocks were inspected by an independent expert retrospectively with regard to the spread of the local anesthetic (LA) and accidental intraneural injection.Results: Cumulative single nerve measurements and temperature changes revealed significant shorter onset and better efficacy (dist/prox: 15 min: 3.13 ± 1.86/1.82 ± 1.62; 30 min: 5.73 ± 1.92/3.21 ± 1.88; T15 min: 30.3 ± 3.48/28.0 ± 3.67, T30 min. 33.0 ± 2.46/30.6 ± 3.86; MV/SD; ANOVA; p < 0.01) combined with a higher rate of subparaneural spread in the dist. group (41/51 vs.12/53; χ2; p < 0,01). Procedure times were similar. There were no complications in either group.Discussion: The subparaneural spread of the LA turned out to be crucial for better results in the distal group. The steep angle using the out-of-plane approach favors needle penetration through the paraneural sheath. The distance between the branches allows the safe application of the LA, so an effective block can be done with just one injection.Conclusion: DSB slightly distal to the bifurcation, in an out-of-plane technique between the TN and CFN, can be done fast, effectively and safe. [ABSTRACT FROM AUTHOR]

Background: Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school.Objectives: This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology.Materials and Methods: After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group.Results: 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110).Conclusion: With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently. [ABSTRACT FROM AUTHOR]

Background: Unanticipated airway problems in infants can rapidly develop into severe hypoxemia. Team members can provide support and suggest steps of action if a shared mental model of the next steps exists. Briefing prior to induction of anaesthesia may create such a shared mental model among all team members.Objectives: The aim of the study was to assess whether a short briefing on the recommendations for an unexpected difficult airway, developed by the Working Group on Paediatric Anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine, would influence the management of an unexpected difficult mask ventilation in an infant. The study also aims to assess whether a shared mental model would encourage the anaesthesia nurse to speak up and foster implicit coordination.Methods: Nineteen teams consisting of an anaesthesia resident and an anaesthesia nurse participated in a scenario of an urgent induction of anaesthesia in an infant. Teams were randomized to either conduct a briefing on the recommendations for an unexpected difficult airway prior to induction of anaesthesia or to have access to a Web-based cognitive aid with an emergency manual page containing the identical algorithm if needed. Induction of anaesthesia triggered upper airway obstruction and desaturation. The time course of desaturation followed published physiologic modelling. The time until the obstruction was relieved was recorded. Video recordings of the scenarios were analysed with respect to coordination patterns prior to induction as well as to coordination forms (implicit vs. explicit) during the emergency. At the end of the course, participants were asked to fill out a questionnaire.Results: Teams of both groups checked on the availability of airway equipment, but teams in the briefing group talked more often about treatment steps to relieve airway obstruction (p < 0.005). The time until the obstruction was relieved was significantly shorter in the briefing group (median: 80 s vs. 126 s; p < 0.005). In 45 % of the intervention scenarios the nurse suggested the solution to the airway problem whereas only 10 % of the nurses in the control group proposed a measure to relieve the obstruction (n.s.). Both groups showed no difference in the frequency of implicit vs. explicit coordination patterns. Nurses from the intervention group found the situation to be less an emergency and felt better prepared than nurses from the control group (p < 0.05).Conclusion: Briefings prior to anaesthesia induction in paediatric anaesthesia should include management of unanticipated problems. In a simulation setting, a briefing on treatment steps for an unexpected difficult airway improves management of an upper airway obstruction. Explicit communication of intended actions by the anaesthesiologist may foster speaking up by team members. [ABSTRACT FROM AUTHOR]

Background: Perioperative care demands consideration of individual treatment goals. We evaluated the attitudes of medical staff towards a short standardized advance directive (SSAD) as a means of improving patient-orientated care at the transition from operating theater to general or intensive care wards.Method: Multicenter anonymized standardized multiple-choice questionnaire among physicians and nurses from various operative and anesthesiology departments. Questions addressing demographic parameters and attitudes towards advance directives in acute care settings (eleven 4‑stepped Likert items). Univariate analysis of group comparisons using the chi-square and Kruskal-Wallis rank-sum test. Multivariable analysis of significant differences employing ordinal logistic regression.Results: The overall return rate was 28.2 % (169 questionnaires). Of these, 19.5 % said that existing advance directives were regularly reassessed preoperatively. SSAD was expected to provide improved emergency care by 82.3 and 76.6 % thought that it would help to better focus intensive care resources according to patients' needs.Discussion: Our study shows the dilemma of insufficiently structured directives for changing treatment goals as well as a high number of legal procedures to obtain proxy decisions due to missing out-patient advance health planning. From a medical staff perspective there is strong support for the concept of SSAD based on medical, ethical, economic and organizational reasons. [ABSTRACT FROM AUTHOR]

Background: The correct placement of an endotracheal tube in children is essential as incorrect placement following unilateral ventilation and tube displacement may lead to far-reaching consequences, such as volutrauma and hypoxia, respectively. Different formulae referring to the correct placement of nasotracheal and orotracheal tubes have been published with reference to body weight and age.Objective: The aim of the present review article was to identify and compare the published formulae for estimating correct endotracheal tube placement in children with their advantages and disadvantages.Material and Methods: A search in Medline and PubMed was performed to identify published formulae. Formulae for insertion depth in orotracheal and also nasotracheal intubation are discussed. The published formulae for newborns and infants are presented separately. The keywords "paediatric"/"pediatric", "anaesthesia"/"anesthesia", "anaesthesiology"/"anesthesiology", "endotracheal tube", "placement", "position", "length", "depth" and "insertion" were used to identify the formulae.Results: A total of 806 publications were found, 16 publications were identified as being relevant and 13 different formulae were identified. In the age group from 1 to 16 years old a total of 7 formulae (6 age-based formulae and one based on weight) and for newborns and infants a total of 6 formulae (4 formulae based on body weight, 1 formula based on body length and 1 formula based on gestational age) were found. All publications were subsequently assessed and classified independently by a specialist physician in anesthesiology and a specialist physician in pediatrics.Conclusion: The published formulae were comparatively simply to apply but had notable limitations. Correlating the position of the endotracheal tubes with chest x-rays, the concordance analysis showed that for the age-based formulae using orotracheal as well as nasotracheal intubation and in both age groups, an accordance could only be achieved in a maximum of 81%. In the presence of a lack of alternative possibilities, only one formula based on the gestational age seemed to have an impact on estimation of correct endotracheal tube depth placement in newborns and infants. Therefore, a generally valid formula cannot be recommended without verification by auscultation or chest x-ray. [ABSTRACT FROM AUTHOR]

Introduction: Meaningful activity is both the means and aim of occupational therapy. Clientcenteredness, orientation to resources, daily-life, and occupation as characteristics of the KRAH®-approach and constituents of its acronym, are intended to facilitate positive experiences of self-efficacy through engagement in meaningful activities. This study aimed to explore the effect of meaningful activity as therapeutic means and aim of KRAH®-based occupational therapy on aspects of health as perceived by children with difficulties in their occupational performance, and their parents, teachers, and occupational therapists. Methods: Occupational therapists in Austria and Italy (South Tyrol) conducted KRAH®-based occupational therapy with 19 children. After 10 sessions, 16 children (5;2 to 8;9 years old), 15 parents, 12 occupational therapists, and 11 teachers evaluated the intervention. Data were analysed using descriptive statistics and qualitative content analysis, investigating the effects of KRAH®-based interventions on the children's volition, occupational performance, and on health factors according to the International Classification of Functioning, Disability, and Health -- Child and Youth Version (ICF-CY). Results: From the perspective of all study participants, KRAH®-based intervention showed positive effects on the children's self-confidence, volition, occupational performance, occupational interests, and participation. Conclusion: KRAH®-based intervention, using meaningful activity as therapeutic means and aim, has shown to promote the health of children with occupational performance difficulties. [ABSTRACT FROM AUTHOR]

Introduction: The recent years saw repeated demands for an improved cooperation between the stakeholders in the public health service. The evaluation study carried out on the interdisciplinary degree programme Health Care Studies lays its focus on interprofessional collaboration in the context of health care. Method: Students of the dual degree programme (N=364) and students with professional experience (N=133) were interviewed after the second term. Results: With about 80% the main motive for studying is the improvement of job perspectives, while interdisciplinarity receives only under 20%. More than 50% give great importance to professional topcis. 40% of students with professional experience and 30% of students of the dual degree program ascribe relevance to interdisciplinary modules. On the basis of respondents' free text, three categories of the meaning of collaboration were identified: 1. improvement of patient care; 2. advancement of exchange and community; 3. improvement and reflection of one's work. Conclusion: All respondents stressed the importance of collaboration. However, professional competences in one's professional discipline are necessary preconditions for practising interdisciplinarity. The academic acquisition of competences is a building block for the improvement of collaboration in public health. However, degree programmes alone cannot lead to a breakthrough. Legal measures and changes of the structural framework are also a necessary condition. [ABSTRACT FROM AUTHOR]

Beginning with an examination of both the empirical results and different ontological evaluations of neuroscientific research on the phenomenon of the will, this inquiry asks whether human will is to be described as bound or free, and whether an appropriate understanding of human will is to be seen in either a deterministic or an indeterministic understanding of the world. A reexamination of Luther's anthropological claims about the problem of will and the present theological debate leads to the main theses: Given the understanding of the human person as a particular, eschatically constituted whence-and-whither- being in process possessing either a misplaced or a reconciled self-disclosedness, human will has to be understood as being bound to different factors to both internal and external determinants, as well as to internal and external contingency. Human will, therefore, is always bound, meaning that one has to opt for a form of compatibilism. However, this compatibilism must be conceived as being compatible with both determinism and indeterminism. The paper concludes by introducing suggestions about the experience of free will under the conditions of an ontologically bound will and a brief reflexion on the concept of responsibility. [ABSTRACT FROM AUTHOR]