WHEDA study: Effectiveness of occupational therapy at home for older people with dementia and their caregivers - the design of a pragmatic randomised controlled trial evaluating a Dutch programme in seven German centres

Contains fulltext : 80941.pdf (publisher's version ) (Open Access)BACKGROUND: A recent Dutch mono-centre randomised controlled trial has shown that occupational therapy improves daily functioning in dementia. The aim of this present study is to compare the effects of the Dutch community occupational therapy programme with a community occupational therapy consultation on daily functioning in older people with mild or moderate dementia and their primary caregivers in a German multi-centre context. METHODS/DESIGN: A multi-centre single blind randomised controlled trial design is being used in seven health care centres (neurological, psychiatric and for older people) in urban regions. Patients are 1:1 randomised to treatment or control group. Assessors are blind to group assignment and perform measurements on both groups at baseline, directly after intervention at 6 weeks and at 16, 26 and 52 weeks follow-up. A sample of 140 community dwelling older people (aged >65 years) with mild or moderate dementia and their primary caregivers is planned. The experimental intervention consists of an evidence-based community occupational therapy programme including 10 sessions occupational therapy at home. The control intervention consists of one community occupational therapy consultation based on information material of the Alzheimer Society. Providers of both interventions are occupational therapists experienced in treatment of cognitively impaired older people and trained in both programmes. 'Community' indicates that occupational therapy intervention occurs in the person's own home. The primary outcome is patients' daily functioning assessed with the performance scale of the Interview for Deterioration in Daily Living Activities in Dementia and video tapes of daily activities rated by external raters blind to group assignment using the Perceive, Recall, Plan and Perform System of Task Analysis. Secondary outcomes are patients' and caregivers' quality of life, mood and satisfaction with treatment; the caregiver's sense of competence, caregiver's diary (medication, resource utilisation, time of informal care); and the incidence of long-term institutionalisation. Process evaluation is performed by questionnaires and focus group discussion. DISCUSSION: The transfer from the Dutch mono-centre design to the pragmatic multi-site trial in a German context implicates several changes in design issues including differences in recruitment time, training of interventionists and active control group treatment.The study is registered under DRKS00000053 at the German register of clinical trials, which is connected to the International Clinical Trials Registry Platform

Der Einfluss von instrumentellen Handlungen und hervorgerufenen Selbsterklärungen auf den physikalischen Wissenserwerb in der Primarstufe

Lernen mit oder durch Handlungen, wie z. B. beim ‚Experimentieren‘, gilt als ein zentrales Merkmal des naturwissenschaftlichen Unterrichts und insbesondere des naturwissenschaftlichen Sachunterrichts. Ausgangspunkt bei Letzterem sind oft ‚Phänomene‘. Die handlungsorientierte Begegnung mit einem Phänomen gilt dabei als Idealbild des naturwissenschaftlichen Sachunterrichts. Hingegen ist die postulierte Wirkung eines handlungsorientierten Lernens empirisch nicht ausreichend überprüft. Notwendig für ein erfolgreiches Lernen ist auch im naturwissenschaftlichen Sachunterricht die kognitive Aktivität der Schülerinnen und Schüler. Die Aufforderung zu Selbsterklärungen gilt als robuste Methode der kognitiven Aktivierung, die den Aufbau von Wissensstrukturen unterstützt. Inwieweit diese Methode in der Primarstufe wirkungsvoll ist, ist ebenfalls noch nicht eindeutig geklärt. Ob eine Handlungsorientierung und eine kognitive Aktivierung durch die Aufforderung zu Selbsterklärungen den Wissenserwerb im naturwissenschaftlichen Sachunterricht der Primarstufe unterstützen, wird daher in einer experimentellen Laborstudie untersucht. Als Phänomen wurde die optische Abbildung mit der Lochkamera gewählt. Es zeigt sich, dass Selbsterklärungen den Wissenserwerb mit einem großen Effekt unterstützen. Eine handlungsorientierte Vermittlung zeigt hingegen gegenüber einer vergleichbaren Vermittlung mit Bildern keinen Effekt

Der Einfluss von instrumentellen Handlungen und hervorgerufenen Selbsterklärungen auf den physikalischen Wissenserwerb in der Primarstufe

Lernen mit oder durch Handlungen, wie z. B. beim ‚Experimentieren‘, gilt als ein zentrales Merkmal des naturwissenschaftlichen Unterrichts und insbesondere des naturwissenschaftlichen Sachunterrichts. Ausgangspunkt bei Letzterem sind oft ‚Phänomene‘. Die handlungsorientierte Begegnung mit einem Phänomen gilt dabei als Idealbild des naturwissenschaftlichen Sachunterrichts. Hingegen ist die postulierte Wirkung eines handlungsorientierten Lernens empirisch nicht ausreichend überprüft. Notwendig für ein erfolgreiches Lernen ist auch im naturwissenschaftlichen Sachunterricht die kognitive Aktivität der Schülerinnen und Schüler. Die Aufforderung zu Selbsterklärungen gilt als robuste Methode der kognitiven Aktivierung, die den Aufbau von Wissensstrukturen unterstützt. Inwieweit diese Methode in der Primarstufe wirkungsvoll ist, ist ebenfalls noch nicht eindeutig geklärt. Ob eine Handlungsorientierung und eine kognitive Aktivierung durch die Aufforderung zu Selbsterklärungen den Wissenserwerb im naturwissenschaftlichen Sachunterricht der Primarstufe unterstützen, wird daher in einer experimentellen Laborstudie untersucht. Als Phänomen wurde die optische Abbildung mit der Lochkamera gewählt. Es zeigt sich, dass Selbsterklärungen den Wissenserwerb mit einem großen Effekt unterstützen. Eine handlungsorientierte Vermittlung zeigt hingegen gegenüber einer vergleichbaren Vermittlung mit Bildern keinen Effekt

Electronic Mobile Devices in Environmental Education (EE) and Education for Sustainable Development (ESD) – Evaluation of Concepts and Potentials

AbstractMobile electronic devices with integrated GPS receivers are being used with increasing popularity for EE and ESD. The research project of Ludwigsburg University of Education intends to bring the discussion on the potentials and limitations of these new educational technologies to a more objective level. The objective is a systematic review of practical approaches to evaluate the quality and potentials of mobile learning from different perspectives: technical, methodological and content-driven dimensions. These dimensions are framed in a pedagogical-didactic context leading to opposite poles, such as educational offers, teaching-learning paradigms and action control. The results reveal the status quo and unused potentials of mobile learning in EE/ESD

Dual guidance structure for evaluation of patients with unclear diagnosis in centers for rare diseases (ZSE-DUO): study protocol for a controlled multi-center cohort study

Background In individuals suffering from a rare disease the diagnostic process and the confirmation of a final diagnosis often extends over many years. Factors contributing to delayed diagnosis include health care professionals' limited knowledge of rare diseases and frequent (co-)occurrence of mental disorders that may complicate and delay the diagnostic process. The ZSE-DUO study aims to assess the benefits of a combination of a physician focusing on somatic aspects with a mental health expert working side by side as a tandem in the diagnostic process. Study design This multi-center, prospective controlled study has a two-phase cohort design. Methods Two cohorts of 682 patients each are sequentially recruited from 11 university-based German Centers for Rare Diseases (CRD): the standard care cohort (control, somatic expertise only) and the innovative care cohort (experimental, combined somatic and mental health expertise). Individuals aged 12 years and older presenting with symptoms and signs which are not explained by current diagnoses will be included. Data will be collected prior to the first visit to the CRD’s outpatient clinic (T0), at the first visit (T1) and 12 months thereafter (T2). Outcomes Primary outcome is the percentage of patients with one or more confirmed diagnoses covering the symptomatic spectrum presented. Sample size is calculated to detect a 10 percent increase from 30% in standard care to 40% in the innovative dual expert cohort. Secondary outcomes are (a) time to diagnosis/diagnoses explaining the symptomatology; (b) proportion of patients successfully referred from CRD to standard care; (c) costs of diagnosis including incremental cost effectiveness ratios; (d) predictive value of screening instruments administered at T0 to identify patients with mental disorders; (e) patients’ quality of life and evaluation of care; and f) physicians’ satisfaction with the innovative care approach. Conclusions This is the first multi-center study to investigate the effects of a mental health specialist working in tandem with a somatic expert physician in CRDs. If this innovative approach proves successful, it will be made available on a larger scale nationally and promoted internationally. In the best case, ZSE-DUO can significantly shorten the time to diagnosis for a suspected rare disease

Genome Sequencing of Pediatric Medulloblastoma Links Catastrophic DNA Rearrangements with TP53 Mutations

Genomic rearrangements are thought to occur progressively during tumor development. Recent findings, however, suggest an alternative mechanism, involving massive chromosome rearrangements in a one-step catastrophic event termed chromothripsis. We report the whole-genome sequencing-based analysis of a Sonic-Hedgehog medulloblastoma (SHH-MB) brain tumor from a patient with a germline TP53 mutation (Li-Fraumeni syndrome), uncovering massive, complex chromosome rearrangements. Integrating TP53 status with microarray and deep sequencing-based DNA rearrangement data in additional patients reveals a striking association between TP53 mutation and chromothripsis in SHH-MBs. Analysis of additional tumor entities substantiates a link between TP53 mutation and chromothripsis, and indicates a context-specific role for p53 in catastrophic DNA rearrangements. Among these, we observed a strong association between somatic TP53 mutations and chromothripsis in acutemyeloid leukemia. These findings connect p53 status and chromothripsis in specific tumor types, providing a genetic basis for understanding particularly aggressive subtypes of cance