Educational Games in Geriatric Medicine Education: A Systematic Review

OBJECTIVE: To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. METHODS: We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) and excluded single arm studies. Population of interests included members (practitioners or students) of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. RESULTS: We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. CONCLUSION: The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly.Society of General Internal Medicin

Ready for the world? Measuring the (trans-)national quality of political issue publics on twitter

This article presents a multi-method research design for measuring the (trans-)national quality of issue publics on Twitter. Online communication is widely perceived as having the potential to overcome nationally bound public spheres. Social media, in particular, are seen as platforms and drivers of transnational communication through which users can easily connect across borders. Transnational interactivity can be expected in particular for policy fields of global concern and elite or activist communication as practiced on Twitter. Nevertheless, there is still a lot of evidence for the enduring national structuration of political communication and publics as it results from a shared language (mostly), culturally defined media markets, established routines of social and political communication, and sociocultural stocks of knowledge. The study goes beyond measuring user interaction and also includes indicators of cross-referential cohesion. It applies a set of computational methods in network and discourse analysis and presents empirical evidence for Twitter communication on climate change being a prime issue of global concern and a globalized policy agenda. For empirical analysis, the study relies on a large Twitter dataset (N ≈ 6m tweets) with tweet messages and metadata collected between 2015 and 2018. Based on basic measurements such as geolocation and language use, the metrics allowed measurement of cross-national user interactions, user centrality in communicative networks, linking behaviour, and hashtag co-occurrences. The findings of the exploratory study suggest that a combined perspective on indicators of user interaction and cross-referential cohesion helps to develop a better and more nuanced understanding of online issue publics

A Lightweight Multilevel Markup Language for Connecting Software Requirements and Simulations

[Context] Simulation is a powerful tool to validate specified requirements especially for complex systems that constantly monitor and react to characteristics of their environment. The simulators for such systems are complex themselves as they simulate multiple actors with multiple interacting functions in a number of different scenarios. To validate requirements in such simulations, the requirements must be related to the simulation runs. [Problem] In practice, engineers are reluctant to state their requirements in terms of structured languages or models that would allow for a straightforward relation of requirements to simulation runs. Instead, the requirements are expressed as unstructured natural language text that is hard to assess in a set of complex simulation runs. Therefore, the feedback loop between requirements and simulation is very long or non-existent at all. [Principal idea] We aim to close the gap between requirements specifications and simulation by proposing a lightweight markup language for requirements. Our markup language provides a set of annotations on different levels that can be applied to natural language requirements. The annotations are mapped to simulation events. As a result, meaningful information from a set of simulation runs is shown directly in the requirements specification. [Contribution] Instead of forcing the engineer to write requirements in a specific way just for the purpose of relating them to a simulator, the markup language allows annotating the already specified requirements up to a level that is interesting for the engineer. We evaluate our approach by analyzing 8 original requirements of an automotive system in a set of 100 simulation runs

The Malleable Politics of Welfare-to-Work Reform: Germany's "Hartz" activation compared with Dutch, British and Irish cases. ACES Cases No. 2009.1

We compare the Hartz reforms in Germany with three other major labor market activation reforms carried out by center-left governments. Britain and Germany developed radically neoliberal “mandatory” activation policies, whereas in the Netherlands and Ireland radical activation change took a very different “enabling” form. The Irish and German cases were path deviant, the British and Dutch path dependent. We explain why Germany underwent “mandatory” and path deviant activation by focusing on two features of the policy discourse. First, the elite level discourse was “ensilaged” sealing policy formation off from dissenting actors. This is what the British and German cases had in common and the result was reform that identified long term unemployment as social delinquency rather than market failure. Second, although the German policy-making system lacked the “authoritative” features that facilitated reform in the British case, and the Irish policy-making system lacked the “reflexive” mechanisms that facilitated reform in the Dutch case, in both Germany and Ireland the wider legitimating discourses were reshaped by novel institutional vehicles (the Hartz Commission and FÁS) that served to fundamentally alter system-constitutive perceptions about policy. The findings suggest that major reform of welfare-to-work policy may be much more malleable than previously thought

Assessing and presenting summaries of evidence in Cochrane Reviews

Cochrane Reviews are intended to help providers, practitioners and patients make informed decisions about health care. The goal of the Cochrane Applicability and Recommendation Methods Group (ARMG) is to develop approaches, strategies and guidance that facilitate the uptake of information from Cochrane Reviews and their use by a wide audience with specific focus on developers of recommendations and on healthcare decision makers. This paper is part of a series highlighting developments in systematic review methodology in the 20 years since the establishment of The Cochrane Collaboration, and its aim is to present current work and highlight future developments in assessing and presenting summaries of evidence, with special focus on Summary of Findings (SoF) tables and Plain Language Summaries. A SoF table provides a concise and transparent summary of the key findings of a review in a tabular format. Several studies have shown that SoF tables improve accessibility and understanding of Cochrane Reviews. The ARMG and GRADE Working Group are working on further development of the SoF tables, for example by evaluating the degree of acceptable flexibility beyond standard presentation of SoF tables, developing SoF tables for diagnostic test accuracy reviews and interactive SoF tables (iSoF). The plain language summary (PLS) is the other main building block for dissemination of review results to end-users. The PLS aims to summarize the results of a review in such a way that health care consumers can readily understand them. Current efforts include the development of a standardized language to describe statistical results, based on effect size and quality of supporting evidence. Producing high quality PLS and SoF tables and making them compatible and linked would make it easier to produce dissemination products targeting different audiences (for example, providers, health policy makers, guideline developers). Current issues of debate include optimal presentation formats of SoF tables, the training required to produce SoF tables, and the extent to which the authors of Cochrane Reviews should provide explicit guidance to target audiences of patients, clinicians and policy-makers

Improving the use of research evidence in guideline development: 2. Priority setting

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the second of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on priority setting for health care guidelines, recommendations and technology assessments. METHODS: We searched PubMed and three databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct systematic reviews ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: There is little empirical evidence to guide the choice of criteria and processes for establishing priorities, but there are broad similarities in the criteria that are used by various organisations and practical arguments for setting priorities explicitly rather than implicitly, WHAT CRITERIA SHOULD BE USED TO ESTABLISH PRIORITIES? • WHO has limited resources and capacity to develop recommendations. It should use these resources where it has the greatest chance of improving health, equity, and efficient use of healthcare resources. • We suggest the following criteria for establishing priorities for developing recommendations based on WHO's aims and strategic advantages: • Problems associated with a high burden of illness in low and middle-income countries, or new and emerging diseases. • No existing recommendations of good quality. • The feasibility of developing recommendations that will improve health outcomes, reduce inequities or reduce unnecessary costs if they are implemented. • Implementation is feasible, will not exhaustively use available resources, and barriers to change are not likely to be so high that they cannot be overcome. • Additional priorities for WHO include interventions that will likely require system changes and interventions where there might be a conflict in choices between individual and societal perspectives. WHAT PROCESSES SHOULD BE USED TO AGREE ON PRIORITIES? • The allocation of resources to the development of recommendations should be part of the routine budgeting process rather than a separate exercise. • Criteria for establishing priorities should be applied using a systematic and transparent process. • Because data to inform judgements are often lacking, unmeasured factors should also be considered – explicitly and transparently. • The process should include consultation with potential end users and other stakeholders, including the public, using well-constructed questions, and possibly using Delphi-like procedures. • Groups that include stakeholders and people with relevant types of expertise should make decisions. Group processes should ensure full participation by all members of the group. • The process used to select topics should be documented and open to inspection. SHOULD WHO HAVE A CENTRALISED OR DECENTRALISED PROCESS? • Both centralised and decentralised processes should be used. Decentralised processes can be considered as separate "tracks". • Separate tracks should be used for considering issues for specific areas, populations, conditions or concerns. The rationales for designating special tracks should be defined clearly; i.e. why they warrant special consideration. • Updating of guidelines could also be considered as a separate "track", taking account of issues such as the need for corrections and the availability of new evidence

Improving the use of research evidence in guideline development: 6. Determining which outcomes are important

BACKGROUND: The World Health Organization (WHO), like many other organisations around the world, has recognised the need to use more rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the sixth of a series of 16 reviews that have been prepared as background for advice from the WHO Advisory Committee on Health Research to WHO on how to achieve this. OBJECTIVES: We reviewed the literature on determining which outcomes are important for the development of guidelines. METHODS: We searched five databases of methodological studies for existing systematic reviews and relevant methodological research. We did not conduct a complete systematic review ourselves. Our conclusions are based on the available evidence, consideration of what WHO and other organisations are doing and logical arguments. KEY QUESTIONS AND ANSWERS: We did not find a systematic review that addresses any of the following key questions and we found limited relevant research evidence. What methods should WHO use to identify important outcomes? • Methods of outcome identification should be transparent and explicit. • The consultation process should start with identification of all relevant outcomes associated with an intervention. • Those affected, including consumers, should be involved in the selection of outcomes. • A question driven approach (what is important?) is preferable to a data driven approach (what data are at hand?) to identify important outcomes. What type of outcomes should WHO consider and how should cultural diversity be taken account of in the selection of outcomes? • Desirable (benefits, less burden and savings) and undesirable effects should be considered in all guidelines. • Undesirable effects include harms (including the possibility of unanticipated adverse effects), greater burden (e.g. having to go to the doctor) and costs (including opportunity costs). • Important outcomes (e.g. mortality, morbidity, quality of life) should be preferred over surrogate, indirect outcomes (e.g. cholesterol levels, lung function) that may or may not correlate with patient important outcomes. • Ethical considerations should be part of the evaluation of important outcomes (e.g. impacts on autonomy). • If the importance of outcomes is likely to vary across cultures, stakeholders from diverse cultures should be consulted and involved in the selection of outcomes. How should the importance of outcomes be ranked? • Outcomes should be ranked by relative importance, separated into benefits and downsides. • Information from research on values and preferences should inform the ranking of outcomes whenever possible. • If the importance of outcomes is likely to vary across cultures, ranking of outcomes should be done in specific settings. • If evidence is lacking for an important outcome, this should be acknowledged, rather than ignoring the outcome

Dogs distinguish human intentional and unintentional action

When dogs interact with humans, they often show appropriate reactions to human intentional action. But it is unclear from these everyday observations whether the dogs simply respond to the action outcomes or whether they are able to discriminate between different categories of actions. Are dogs able to distinguish intentional human actions from unintentional ones, even when the action outcomes are the same? We tested dogs’ ability to discriminate these action categories by adapting the so-called “Unwilling vs. Unable” paradigm. This paradigm compares subjects’ reactions to intentional and unintentional human behaviour. All dogs received three conditions: In the unwilling-condition, an experimenter intentionally withheld a reward from them. In the two unable-conditions, she unintentionally withheld the reward, either because she was clumsy or because she was physically prevented from giving the reward to the dog. Dogs clearly distinguished in their spontaneous behaviour between unwilling- and unable-conditions. This indicates that dogs indeed distinguish intentional actions from unintentional behaviour. We critically discuss our findings with regard to dogs’ understanding of human intentional action.Results - Analysis of waiting - Other behavioural reactions Discussion Methods - Ethical statement - Subjects - Experimental set‑up - Procedure - Codin

Der EU-Verfassungsprozess und die ungleichzeitige Widerständigkeit gesellschaftlicher Wissensordnungen – exemplarische Darstellung eines Ansatzes zur diskursanalytischen Referendumsforschung

Dieser Beitrag beschreibt eine umfassende Studie zu drei EU-Vertragsreferenden (in Frankreich, den Niederlanden und Irland). Sie vermeidet die den gängigen Verfahren der Wahl- und Einstellungsforschung eigene artifizielle Trennung der Wahlentscheidung von den diskursiven Prozessen, aus denen diese notwendig hervorgeht. Auf der Grundlage der Wissenssoziologischen Diskursanalyse wird ein komplexes Untersuchungsdesign entwickelt, das die interpretative Rekonstruktion der diskursiven Prozesse in Referendumsdebatten erlaubt und sie einem systematischen Vergleich zuführt. Damit wird zum einen ein neuartiger Ansatz einer diskursanalytischen Referendumsforschung vorgestellt, zum anderen ergibt sich mit der ungleichzeitigen Widerständigkeit gesellschaftlicher Wissensordnungen auch eine theoretische Überlegung