Morbiditäts- und Mortalitätskonferenzen in Niedersachsen: Status quo und Weiterentwicklungsbedarf

BACKGROUND Morbidity and mortality conferences (M&MC) are a tool to foster individual and organizational learning in hospitals, and they are important to improve patient safety. So far, no data has been available about the implementation of M&MC in Lower Saxony and the characteristics of M&MCs. The aim of this study was to assess the status quo of M&MC in Lower Saxony and to identify the potential for improvement. METHODS A cross-sectional survey study was conducted among chief physicians in surgery, internal medicine, anesthesiology/intensive care, gynecology/obstetrics and pediatrics (response rate: 50 %). RESULTS Apart from technical topics (37 %), the main issues addressed are process (92 %) and teamwork (64 %) issues. The results also show a strong heterogeneity in terms of structures and processes of implemented M&MC in Lower Saxony. Despite a high level of satisfaction (85 %) and perceived effectiveness (93 %), most participants see potential for improvement of "their" M&MC (58 %). CONCLUSION Chief physicians in Lower Saxony report both a high level of acceptance and the need for further improvement of the M&MCs, which represents good preconditions for further development towards effective M&MCs.Zusammenfassung Hintergrund Morbiditäts- und Mortalitätskonferenzen (MMK) sind ein Instrument sowohl des individuellen als auch des organisationalen Lernens in Krankenhäusern und wichtig für die Verbesserung der Patientensicherheit. Bisher war allerdings unklar, wie verbreitet die MMK in Niedersachsen ist und wie sie umgesetzt wird. Das Ziel der Studie war, den Status Quo der MMK in Niedersachsen zu erfassen und Verbesserungspotenzial zu eruieren. Methode Es wurde eine Querschnittstudie mittels Online-Befragung von Chefärztinnen und -ärzten der chirurgischen Fächer, internistischen Fächer, der Anästhesiologie/Intensivmedizin, der Gynäkologie/Geburtshilfe und Pädiatrie durchgeführt (Rücklauf-Quote: 50%). Resultate In den MMK werden neben fachlichen Themen (37%) zunehmend Probleme in den Prozessen (92%) und der Zusammenarbeit (64%) besprochen. Die Resultate zeigen auch, dass die MMK in Niedersachsen bezüglich Struktur und Prozessen sehr heterogen sind. Trotz hoher Zufriedenheit (85%) und subjektiv eingeschätzter Wirksamkeit (93%) der MMK sehen die meisten Teilnehmenden Verbesserungspotenzial (58%). Schlussfolgerung Da generell sowohl eine hohe Akzeptanz als auch das Bedürfnis nach einer Weiterentwicklung sichtbar sind, existieren gute Voraussetzungen, die MMK weiterzuentwickeln

Differentiation dependent expression of urocortin’s mRNA and peptide in human osteoprogenitor cells: influence of BMP-2, TGF-beta-1 and dexamethasone

Urocortin-1 (UCN) a corticotropin releasing-factor (CRF) related peptide, has been found to be expressed in many different tissues like the central nervous system, the cardiovascular system, adipose tissue, and skeletal muscle. The effects of UCN are mediated via stimulation of CRF-receptors 1 and 2 (CRFR1 and 2, CRFR’s) with a high affinity for CRFR2. It has been shown that the CRF-related peptides and CRFR’s are involved in the regulation of stress-related endocrine, autonomic and behavioural responses. Using immunocytochemistry, immunohistochemistry and RT–PCR, we now can show the differentiation dependent expression of UCN mRNA and peptide in human mesenchymal progenitor cells (MSCs) directed to the osteoblastic phenotype for the first time. UCN expression was down regulated by TGF-beta and BMP-2 in the early proliferation phase of osteoblast development, whereas dexamethasone (dex) minimally induced UCN gene expression during matrix maturation after 24 h stimulation. Stimulation of MSCs for 28 days with ascorbate/beta-glycerophosphate (asc/bGp) induced UCN gene expression at day 14. This effect was prevented when using 1,25-vitamin D3 or dex in addition. There was no obvious correlation to osteocalcin (OCN) gene expression in these experiments. In MSCs from patients with metabolic bone disease (n = 9) UCN gene expression was significantly higher compared to MSCs from normal controls (n = 6). Human MSCs did not express any of the CRFR’s during differentiation to osteoblasts. Our results indicate that UCN is produced during the development of MSCs to osteoblasts and differentially regulated during culture as well as by differentiation factors. The expression is maximal between proliferation and matrix maturation phase. However, UCN does not seem to act on the osteoblast itself as shown by the missing CRFR’s. Our results suggest new perspectives on the role of urocortin in human skeletal tissue in health and disease

Effects of low-frequency whole-body vibration on motor-evoked potentials in healthy men.

addresses: Sport and Exercise Science Research Centre, Faculty of Engineering, Science and The Built Environment, London South Bank University, 103 Borough Road, London SE1 0AA, UK. [email protected] is the author's post-print version of an article published in Experimental Physiology, 2009, Vol. 94, Issue 1, pp. 103 - 116 Copyright © 2009 Wiley-Blackwell /The Physiological Society. The definitive version is available at www3.interscience.wiley.comThe aim of this study was to determine whether low-frequency whole-body vibration (WBV) modulates the excitability of the corticospinal and intracortical pathways related to tibialis anterior (TA) muscle activity, thus contributing to the observed changes in neuromuscular function during and after WBV exercise. Motor-evoked potentials (MEPs) elicited in response to transcranial magnetic stimulation (TMS) of the leg area of the motor cortex were recorded in TA and soleus (SOL) muscles of seven healthy male subjects whilst performing 330 s continuous static squat exercise. Each subject completed two conditions: control (no WBV) and WBV (30 Hz, 1.5 mm vibration applied from 111 to 220 s). Five single suprathreshold and five paired TMS were delivered during each squat period lasting 110 s (pre-, during and post-WBV). Two interstimulus intervals (ISIs) between the conditioning and the testing stimuli were employed in order to study the effects of WBV on short-interval intracortical inhibition (SICI, ISI = 3 ms) and intracortical facilitation (ICF, ISI = 13 ms). During vibration relative to squat exercise alone, single-pulse TMS provoked significantly higher TA MEP amplitude (56 +/- 14%, P = 0.003) and total area (71 +/- 19%, P = 0.04), and paired TMS with ISI = 13 ms provoked smaller MEP amplitude (-21 +/- 4%, P = 0.01) but not in SOL. Paired-pulse TMS with ISI = 3 ms elicited significantly lower MEP amplitude (TA, -19 +/- 4%, P = 0.009; and SOL, -13 +/- 4%, P = 0.03) and total area (SOL, -17 +/- 6%, P = 0.02) during vibration relative to squat exercise alone in both muscles. Tibialis anterior MEP facilitation in response to single-pulse TMS suggests that WBV increased corticospinal pathway excitability. Increased TA and SOL SICI and decreased TA ICF in response to paired-pulse TMS during WBV indicate vibration-induced alteration of the intracortical processes as well

The interpretations and uses of fitness landscapes in the social sciences

__Abstract__ This working paper precedes our full article entitled “The evolution of Wright’s (1932) adaptive field to contemporary interpretations and uses of fitness landscapes in the social sciences” as published in the journal Biology & Philosophy (http://link.springer.com/article/10.1007/s10539-014-9450-2). The working paper features an extended literature overview of the ways in which fitness landscapes have been interpreted and used in the social sciences, for which there was not enough space in the full article. The article features an in-depth philosophical discussion about the added value of the various ways in which fitness landscapes are used in the social sciences. This discussion is absent in the current working paper. Th

The Digital Transformation of Search and Recombination in the Innovation Function: Tensions and an Integrative Framework*

Search and recombination are important mechanisms in the creativity phase of innovation. Digital transformation and the resulting pervasive digitalization of the innovation function have often been associated with increasing possibilities for search and recombination. In this paper, by systematically integrating the search and recombination literature with the literature on digitalization, we demonstrate that digitalization may engender new idiosyncratic tensions in the organizational antecedents of search and recombination and, by implication, in their likely outcomes. We propose that, depending on the interactions among the idiosyncratic tensions identified herein, knowledge recombination might spur very different outcomes, including knowledge layering, knowledge integration, knowledge grafting, or even no recombination at all (which we label “search for the sake of search”). These outcomes may not always be the initially planned desired outcomes. Finally, we provide implications of our integrative framework pertaining to product development and to organizing for innovation

When workplace unionism in global value chains does not function well : exploring the impediments

Improving working conditions at the bottom of global value chains has become a central issue in our global economy. In this battle, trade unionism has been presented as a way for workers to make their voices heard. Therefore, it is strongly promoted by most social standards. However, establishing a well-functioning trade union is not as obvious as it may seem. Using a comparative case study approach, we examine impediments to farm-level unionism in the cut flower industry in Ethiopia. For this purpose, we propose an integrated framework combining two lenses, namely a vertical one (governance and structure of global value chains) and a horizontal one (socio-economic context). We identify 10 impediments that point to three major dimensions contributing to unionisation. These three dimensions include awareness of and interest from workers, legitimacy of trade unions, and capacity of trade unions to act. Furthermore, our results suggest that private social standards may, in certain cases, be counterproductive for the efficient functioning of trade unions. Although we argue that there is no ‘quick fix’ solution to weak workplace unionism at the bottom of global value chains, we stress the importance of considering the dynamics of, and interactions between, the impediments when designing potential support measures that mitigate negative impacts

Convergence in international business ethics? A comparative study of ethical philosophies, thinking style, and ethical decision-making between US and Korean managers

This study investigates the relationship among ethical philosophy, thinking style, and managerial ethical decision-making. Based on the premise that business ethics is a function of culture and time, we attempt to explore two important questions as to whether the national differences in managerial ethical philosophies remain over time and whether the relationship between thinking style and ethical decision-making is consistent across different national contexts. We conducted a survey on Korean managers’ ethical decision-making and thinking style and made a cross-cultural, cross-temporal comparison with the results presented by previous studies that surveyed Korean and US managers with the same questionnaire at different points in time. Our analysis revealed that Korean managers have become more reliant on rule utilitarianism for ethical decision-making over the last two decades, which is dominantly used by US managers, corroborating our convergence hypothesis built on social contracts theory. However, as opposed to previous research, we found that managers with a balanced linear and nonlinear thinking style do not necessarily make more ethical decisions compared to those with a predominantly linear or nonlinear thinking style. This study contributes to international business ethics literature by presenting a theoretical framework that may explain the convergence of ethical philosophies employed by managers in different national contexts over time, and that the relationship between thinking style and managerial ethical decision-making may not be universal, but contingent on contextual factors