Der Umgang mit Fehlern als Merkmal betrieblicher Fehlerkultur und Voraussetzung für Professional Learning

Moderne Unternehmen folgen Philosophien, wonach Beschäftigte Kompetenzen entwickeln und ihr Unternehmen als lernende Organisation begreifen sollen. Das soll das Potenzial des Unternehmens steigern, auf schwer antizipierbare Anforderungen angemessen reagieren zu können. Fehler stellen in diesem Kontext spezielle Lerngelegenheiten dar, zumal flexible Strukturen die Wahrscheinlichkeit erhöhen, dass Fehler geschehen. Jedoch reicht alleine ein Bekenntnis zu einer positiven Fehlerkultur nicht aus, damit im betrieblichen Arbeitsalltag aus Fehlern gelernt wird. Es bedarf eines Umgangs mit Fehlern, der Merkmale einer positiven Fehlerkultur erfüllt. Dieser Beitrag klärt Voraussetzungen des Lernens aus Fehlern und berichtet Ergebnisse von Studien mit Beschäftigten aus unterschiedlichen Industrie- und Dienstleistungsunternehmen. (DIPF/Orig.)Modern enterprises follow philosophies which require employees to develop competencies and understand their enterprise as a learning organization in order to enhance the potential for appropriate reactions on market changes. Dealing with mistakes is a special source for learning in a scenario where flexible structures increase the probability of their occurrence. A positive way of dealing with mistakes should help to learn from them. However, just a commitment to a positive mistake culture (Fehlerkultur) does not guarantee learning from mistakes in daily working life. This contribution addresses the conditions of learning from mistakes and reports findings from empirical studies with employees. (DIPF/Orig.

Selenium-Binding Protein 1 Indicates Myocardial Stress and Risk for Adverse Outcome in Cardiac Surgery

Selenium-binding protein 1 (SELENBP1) is an intracellular protein that has been detected in the circulation in response to myocardial infarction. Hypoxia and cardiac surgery affect selenoprotein expression and selenium (Se) status. For this reason, we decided to analyze circulating SELENBP1 concentrations in patients (n = 75) necessitating cardioplegia and a cardiopulmonary bypass (CPB) during the course of the cardiac surgery. Serum samples were collected at seven time-points spanning the full surgical process. SELENBP1 was quantified by a highly sensitive newly developed immunological assay. Serum concentrations of SELENBP1 increased markedly during the intervention and showed a positive association with the duration of ischemia (ρ = 0.6, p < 0.0001). Elevated serum SELENBP1 concentrations at 1 h after arrival at the intensive care unit (post-surgery) were predictive to identify patients at risk of adverse outcome (death, bradycardia or cerebral ischemia, "endpoint 1"; OR 29.9, CI 3.3-268.8, p = 0.00027). Circulating SELENBP1 during intervention (2 min after reperfusion or 15 min after weaning from the CPB) correlated positively with an established marker of myocardial infarction (CK-MB) measured after the intervention (each with ρ = 0.5, p < 0.0001). We concluded that serum concentrations of SELENBP1 were strongly associated with cardiac arrest and the duration of myocardial ischemia already early during surgery, thereby constituting a novel and promising quantitative marker for myocardial hypoxia, with a high potential to improve diagnostics and prediction in combination with the established clinical parameters

Rigid fibrescope Bonfils: use in simulated difficult airway by novices

<p>Abstract</p> <p>Background</p> <p>The Bonfils intubation fibrescope is a promising alternative device for securing the airway. We examined the success rate of intubation and the ease of use in standardized simulated difficult airway scenarios by physicians. We compared the Bonfils to a classical laryngoscope with Macintosh blade.</p> <p>Methods</p> <p>30 physicians untrained in the use of rigid fibrescopes but experienced in airway management performed endotracheal intubation in an airway manikin (SimMan, Laerdal, Kent, UK) with three different airway conditions. We evaluated the success rate using the Bonfils (Karl Storz, Tuttlingen, Germany) or the Macintosh laryngoscope, the time needed for securing the airway, and subjective rating of both techniques.</p> <p>Results</p> <p>In normal airway all intubations were successful using laryngoscope (100%) vs. 82% using the Bonfils (p < 0.05). In the scenario "tongue oedema" success rate using the Macintosh laryngoscope was 67% and 83% using the Bonfils. In the scenario "decreased cervical range of motion with jaw trismus", success rate using the Macintosh laryngoscope was 84% vs. 76%. In difficult airway scenarios time until airway was secured did not differ between the two devices. Use of Bonfils was rated "easier" in both difficult airway scenarios.</p> <p>Conclusion</p> <p>The Bonfils can be successfully used by physicians unfamiliar with this technique in an airway manikin. The airway could be secured with at least the same success rate as using a Macintosh laryngoscope in difficult airway scenarios. Use of the Bonfils did not delay intubation in the presence of a difficult airway. These results indicate that intensive special training is advised to use the Bonfils effectively in airway management.</p

Comparison of the McGrath® Series 5 and GlideScope® Ranger with the Macintosh laryngoscope by paramedics

<p>Abstract</p> <p>Background</p> <p>Out-of-hospital endotracheal intubation performed by paramedics using the Macintosh blade for direct laryngoscopy is associated with a high incidence of complications. The novel technique of video laryngoscopy has been shown to improve glottic view and intubation success in the operating room. The aim of this study was to compare glottic view, time of intubation and success rate of the McGrath^®Series 5 and GlideScope^®Ranger video laryngoscopes with the Macintosh laryngoscope by paramedics.</p> <p>Methods</p> <p>Thirty paramedics performed six intubations in a randomised order with all three laryngoscopes in an airway simulator with a normal airway. Subsequently, every participant performed one intubation attempt with each device in the same manikin with simulated cervical spine rigidity using a cervical collar. Glottic view, time until visualisation of the glottis and time until first ventilation were evaluated.</p> <p>Results</p> <p>Time until first ventilation was equivalent after three intubations in the first scenario. In the scenario with decreased cervical motion, the time until first ventilation was longer using the McGrath^®compared to the GlideScope^®and AMacintosh (p < 0.01). The success rate for endotracheal intubation was similar for all three devices. Glottic view was only improved using the McGrath^®device (p < 0.001) compared to using the Macintosh blade.</p> <p>Conclusions</p> <p>The learning curve for video laryngoscopy in paramedics was steep in this study. However, these data do not support prehospital use of the McGrath^®and GlideScope^®devices by paramedics.</p

Frequency of hand eczema in the elderly : cross-sectional findings from the German AugUR study

Background: Hand eczema (HE) is a chronic inflammatory skin disease caused by a genetic predisposition and environmental exposures. There is a lack of populationbased studies on skin diseases in the elderly. Objectives: Our aim was to estimate the frequency of HE in the elderly to determine its burden of disease in this particular population. Methods: We analyzed data from the research platform AugUR, a study on chronic diseases in the elderly (n = 1133, ages 70-95 years, mean age 77.6, 45.1% women). Raw frequencies were estimated using self-reports on physician-diagnosed HE from a standardized personal interview. Frequencies were standardized to the Bavarian population weighted by gender and 5-year age-groups. Results: In our sample 2.7% (95% confidence interval [CI] 1.6-4.3) of the paticipants reported to ever have been diagnosed with HE. Among those 57% were male. After standardization, the frequency was estimated at 2.8% (95% CI 1.9-3.9). There were no differences between male and female participants. Conclusions: Compared to other studies on lifetime frequency of HE, our estimates seem to be remarkably lower. More in-depth studies with validated diagnoses are warranted to precisely estimate the burden of HE in the elderly.Projekt DEAL 202

Langevin behavior of the dielectric decrement in ionic liquid water mixtures

We present large scale polarizable simulations of mixtures of the ionic liquids 1-ethyl-3-methylimidazolium trifluoromethanesulfonate and 1-ethyl-3-methylimidazolium dicyanamide with water, where the dielectric spectra, the ion hydration and the conductivity were evaluated. The dielectric decrement, the depression of the dielectric constant of water upon addition of ions, is found to follow a universal functional of Langevin type. Only three physical properties need to be known to describe the complete range of possible concentrations, namely the dielectric constant of pure water, of pure ionic liquid and the linear slope of the dielectric decrement at low ionic liquid concentrations. Both the generalized dielectric constant, as well as the water contribution to the dielectric permittivity follow the functional dependence. We furthermore find that a scaling of van der Waals parameters upon addition of polarizable forces to the force field is necessary to correctly describe the frequency dependent dielectric conductivity and its contribution to the dielectric spectrum, as well as the static electric conductivity, which is also treated in the framework of a pseudolattice theoryThis work was funded by the Austrian Science Fund FWF in the context of Project No. P23494 and by the Cost Action CM 1206: “Exchange on ionic liquids”. Funding from Spanish Ministry of Economy and Competitiveness (Projects MAT2014-57943-C3-1-P and MAT2017-89239-C2-1-P) is gratefully acknowledged. Moreover, this work was funded by the Xunta de Galicia (AGRUP2015/11 and GRC ED431C 2016/001). E. H. is recipient of a DOC Fellowship of the Austrian Academy of Sciences at the Institute of Computational Biological ChemistryS

Establishing PNB-qPCR for quantifying minimal ctDNA concentrations during tumour resection

The analysis of blood plasma or serum as a non-invasive alternative to tissue biopsies is a much-pursued goal in cancer research. Various methods and approaches have been presented to determine a patient’s tumour status, chances of survival, and response to therapy from serum or plasma samples. We established PNB-qPCR (Pooled, Nested, WT-Blocking qPCR), a highly specific nested qPCR with various modifications to detect and quantify minute amounts of circulating tumour DNA (ctDNA) from very limited blood plasma samples. PNB-qPCR is a nested qPCR technique combining ARMS primers, blocking primers, LNA probes, and pooling of multiple first round products for sensitive quantification of the seven most frequent point mutations in KRAS exon 2. Using this approach, we were able to characterize ctDNA and total cell-free DNA (cfDNA) kinetics by selective amplification of KRAS mutated DNA fragments in the blood plasma over the course of tumour resection and the surrounding days. Whereas total cfDNA concentrations increased over the surgical and regenerative process, ctDNA levels showed a different scheme, rising only directly after tumour resection and about three days after the surgery. For the first time, we present insights into the impact of surgery on the release of ctDNA and total cfDNA

The Metabochip, a Custom Genotyping Array for Genetic Studies of Metabolic, Cardiovascular, and Anthropometric Traits

PMCID: PMC3410907This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Multiplexed pancreatic genome engineering and cancer induction by transfection-based CRISPR/Cas9 delivery in mice

Mouse transgenesis has provided fundamental insights into pancreatic cancer, but is limited by the long duration of allele/model generation. Here we show transfection-based multiplexed delivery of CRISPR/Cas9 to the pancreas of adult mice, allowing simultaneous editing of multiple gene sets in individual cells. We use the method to induce pancreatic cancer and exploit CRISPR/Cas9 mutational signatures for phylogenetic tracking of metastatic disease. Our results demonstrate that CRISPR/Cas9-multiplexing enables key applications, such as combinatorial gene-network analysis, in vivo synthetic lethality screening and chromosome engineering. Negative-selection screening in the pancreas using multiplexed-CRISPR/Cas9 confirms the vulnerability of pancreatic cells to Brca2-inactivation in a Kras-mutant context. We also demonstrate modelling of chromosomal deletions and targeted somatic engineering of inter-chromosomal translocations, offering multifaceted opportunities to study complex structural variation, a hallmark of pancreatic cancer. The low-frequency mosaic pattern of transfection-based CRISPR/Cas9 delivery faithfully recapitulates the stochastic nature of human tumorigenesis, supporting wide applicability for biological/preclinical research