Evaluation beruflicher Weiterbildung anhand des Erfolgskriteriums Zeit

In dieser Arbeit wurde untersucht, ob und anhand welcher Indikatoren der Weiterbildungserfolg einer beruflichen Weiterbildung durch die Zeit (Kriterium Zeiterfolg) evaluiert werden kann. Daneben wurde untersucht, inwiefern sich diese Indikatoren durch die Rahmen- und Umfeldbedingungen beeinflussen lassen. Für die Evaluation von beruflichen Weiterbildungen existiert eine Vielzahl an Instrumenten. Die meisten davon betrachten den pädagogischen Nutzen einer Weiterbildung oder den monetären. Gerade für Unternehmen ist es wichtig, den Erfolg einer Maßnahme anhand von Kennzahlen zu betrachten, um erkennen zu können, ob sich der Einsatz gelohnt hat und die Maßnahme gegebenenfalls wiederholt werden sollte. Die monetäre Betrachtung weist allerdings Herausforderungen und Grenzen auf. Sie ist in den wenigsten Fällen direkt durch den Teilnehmenden zu erfassen, durch subjektive Einflüsse bei der Umrechnung fehleranfällig und kann nicht immer alle pädagogischen Ergebnisse einer Weiterbildung abbilden. Der Faktor Zeit hingegen spielt im Unternehmensalltag eine immer größere Rolle (Produktlebenszyklen werden kürzer, Tarifparteien verhandeln explizit über den Zeiteinsatz der Mitarbeitenden) und ist strengen Grenzen unterworfen: Im Gegensatz zu Geld ist Zeit nicht speicherbar und verrinnt unaufhörlich. Dafür kann sie, nicht wie Geld, von jedem einzelnen Mitarbeitenden direkt erlebt und erfasst werden. Anhand einer empirischen Untersuchung durch einen Fragebogen wurden Teilnehmende von beruflichen Weiterbildungen regionaler Weiterbildungsanbieter (v. a. IHK Bodensee-Oberschwaben) untersucht. 79 Personen haben einen Vorher- und einen Hinterherfragebogen ausgefüllt. Neben den Indikatoren der Zeit wurden noch Rahmen- und Umfeldbedingungen erhoben, der Zeiteinsatz und parallel ein etabliertes, klassisches Evaluationsinstrument (Q4TE Grohmann und Kauffeld, 2013) erfasst. Die Untersuchungsergebnisse zeigen, dass der Zeiterfolg durch die Befragung der Teilnehmenden erfassbar ist. Allerdings ist auch dieser subjektiven Einflüssen sowie Rahmen- und Umfeldbedingungen unterworfen. Der Zeiterfolg und das etablierte Instrument Q4TE zeigen Zusammenhänge. Daneben gibt es aber auch viele Variablen des Zeiterfolgs, die zusätzliche Erkenntnisse über den Weiterbildungserfolg liefern können. Darüber hinaus scheint der Zeiterfolg weniger von den Umfeldbedingungen beeinflusst zu werden, als der klassische Trainingserfolg des Q4TE. V. a. für repetitive Tätigkeiten scheint sich die Evaluation über den Zeiterfolg besonders zu eignen. Das Zeiterfolg-Instrument kann daher für die Verantwortlichen im Unternehmen, je nach Weiterbildungsziel, eine ergänzende Möglichkeit sein, dieses besser zu erfassen und der sich steigernden Rolle der Zeit im Unternehmenskontext gerecht zu werden.In this work it was examined whether and by which indicators the success of further training can be evaluated by time (success of time criterion). In addition, it was examined to what extent these time indicators can be influenced by the general and environmental conditions. A large number of instruments exist for the evaluation of further training. Most of them consider the educational benefits of further trainings or the monetary ones. It is particularly important for companies to look at the success of a measure using key figures in order to be able to see whether the effort was worthwhile and whether the measure should be repeated if necessary. From a monetary point of view, however, there are challenges and limits. In very few cases it can be recorded directly by the participant, error-prone due to subjective influences during the conversion and cannot always depict all the pedagogical results of a further training. The time factor, on the other hand, plays an increasingly important role in day-to-day business (product lifecycles are becoming shorter, bargaining partners for collective agreements explicitly negotiate the use of work time by employees) and is subject to strict limits: unlike money, time cannot be stored and is constantly running out. Unlike money, it can be directly experienced and grasped by each individual employee. Based on an empirical study using a questionnaire, participants in further training courses from regional training providers (mainly IHK Bodensee-Oberschwaben) were examined. 79 people filled out a before and after questionnaire. In addition to the indicators of the time success criterion, framework and environmental conditions were also surveyed. As did the use of time and, in parallel, an established, classical evaluation instrument (Q4TE from Grohmann and Kauffeld, 2013) was recorded. The results of the study show that the success of time can be recorded by questioning the participants. However, this is also subject to subjective influences as well as framework and environmental conditions. But the success of time seems to be less influenced by the environmental conditions than the classical training success of the Q4TE. The success of time and the established instrument Q4TE show connections. In addition, there are also many variables of success of time that don`t show any connection and therefore can provide additional insights into the success of further training. The evaluation of success of time seems to be particularly suitable for repetitive activities. The time success instrument can therefore be an additional opportunity for those responsible in the company, depending on the further training goal, to record this better and to do justice to the increasing role of time in the company context

Effect of a pediatric early warning system on all-cause mortality in Hospitalized pediatric patients: The epoch randomized clinical trial

IMPORTANCE: There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. OBJECTIVE: To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. DESIGN, SETTING, AND PARTICIPANTS: A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. INTERVENTIONS: The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. RESULTS: Among 144539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, -0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69]; P =.96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, -0.34 [95% CI, -0.73 to 0.05 per 1000 patient-days]; adjusted rate ratio, 0.77 [95% CI, 0.61 to 0.97]; P =.03). CONCLUSIONS AND RELEVANCE: Implementation of the Bedside Paediatric Early Warning System compared with usual care did not significantly decrease all-cause mortality among hospitalized pediatric patients. These findings do not support the use of this system to reduce mortality

Researching COVID to Enhance Recovery (RECOVER) Adult Study Protocol: Rationale, Objectives, and Design

IMPORTANCE: SARS-CoV-2 infection can result in ongoing, relapsing, or new symptoms or other health effects after the acute phase of infection; termed post-acute sequelae of SARS-CoV-2 infection (PASC), or long COVID. The characteristics, prevalence, trajectory and mechanisms of PASC are ill-defined. The objectives of the Researching COVID to Enhance Recovery (RECOVER) Multi-site Observational Study of PASC in Adults (RECOVER-Adult) are to: (1) characterize PASC prevalence; (2) characterize the symptoms, organ dysfunction, natural history, and distinct phenotypes of PASC; (3) identify demographic, social and clinical risk factors for PASC onset and recovery; and (4) define the biological mechanisms underlying PASC pathogenesis. METHODS: RECOVER-Adult is a combined prospective/retrospective cohort currently planned to enroll 14,880 adults aged ≥18 years. Eligible participants either must meet WHO criteria for suspected, probable, or confirmed infection; or must have evidence of no prior infection. Recruitment occurs at 86 sites in 33 U.S. states, Washington, DC and Puerto Rico, via facility- and community-based outreach. Participants complete quarterly questionnaires about symptoms, social determinants, vaccination status, and interim SARS-CoV-2 infections. In addition, participants contribute biospecimens and undergo physical and laboratory examinations at approximately 0, 90 and 180 days from infection or negative test date, and yearly thereafter. Some participants undergo additional testing based on specific criteria or random sampling. Patient representatives provide input on all study processes. The primary study outcome is onset of PASC, measured by signs and symptoms. A paradigm for identifying PASC cases will be defined and updated using supervised and unsupervised learning approaches with cross-validation. Logistic regression and proportional hazards regression will be conducted to investigate associations between risk factors, onset, and resolution of PASC symptoms. DISCUSSION: RECOVER-Adult is the first national, prospective, longitudinal cohort of PASC among US adults. Results of this study are intended to inform public health, spur clinical trials, and expand treatment options

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection

IMPORTANCE: SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. OBJECTIVE: To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. DESIGN, SETTING, AND PARTICIPANTS: Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. EXPOSURE: SARS-CoV-2 infection. MAIN OUTCOMES AND MEASURES: PASC and 44 participant-reported symptoms (with severity thresholds). RESULTS: A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. CONCLUSIONS AND RELEVANCE: A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC

Combined Photosensitization and Vaccination Enable CD8 T-Cell Immunity and Tumor Suppression Independent of CD4 T-Cell Help

Cytotoxic T lymphocytes (CTLs) are key players in fighting cancer, and their induction is a major focus in the design of therapeutic vaccines. Yet, therapeutic vaccine efficacy is limited, in part due to the suboptimal vaccine processing by antigen-presenting cells (APCs). Such processing typically takes place via the MHC class II pathway for CD4 T-cell activation and MHC class I pathway for activation of CD8 CTLs. We show that a combination of skin photochemical treatment and immunization, so-called photochemical internalization (PCI) facilitated CTL activation due to the photochemical adjuvant effect induced by photosensitizer, oxygen, and light. Mice were immunized intradermally with antigen and photosensitizer, followed by controlled light exposure. PCI-treated mice showed strong activation of CD8 T cells, with improved IFN-γ production and cytotoxicity, as compared to mice immunized without parallel PCI treatment. Surprisingly, the CD8 T-cell effector functions were not impaired in MHC class II- or CD4 T-cell-deficient mice. Moreover, PCI-based vaccination caused tumor regression independent of MHC class II or CD4 T cells presence in melanoma bearing mice. Together, the data demonstrate that PCI can act as a powerful adjuvant in cancer vaccines, even in hosts with impaired T-helper functions