Strukturelle Reform der überörtlichen Sozialhilfe

Das Auseinanderfallen von Aufgabenwahrnehmung und Finanzierungsverantwortung in der organisatorischen Struktur einiger überörtlicher Sozialhilfeträger in Deutschland schafft keine Anreize für eine sparsame Mittelverwendung. In diesem Beitrag wird eine strukturelle Reform vorgeschlagen, die auf dem Konnexitätsprinzip beruht und zu erheblichen Effizienzgewinnen führen kann.Sozialhilfe, Reform, Ausgaben, Gemeinde, Berufliche Integration, Deutschland

Are self-regulation and self-control mediators between psychological basic needs and intrinsic teacher motivation?

The focus of this paper is the investigation of personal and environmental conditions of intrinsic teacher motivation. Teacher motivation and particularly underlying conditions for intrinsic teacher motivation still constitute a peripheral issue in educational and psychological research. The question whether relatively stable personality dispositions predict intrinsic teacher motivation has been largely neglected, too. Following self-determination theory [...] and Kuhl’s Personality-Systems-Interaction Theory [...], we investigate whether perceived support of basic psychological needs (autonomy, competence, and social relatedness), as well as the personality aspects self-regulation (self maintenance) and self-control (goal maintenance) are related to intrinsic teacher motivation. The sample of the survey study consists of 136 Austrian secondary school teachers. Structural equation modeling supports a model in which self-regulation serves as a mediator between the perceived support of basic needs and intrinsic teacher motivation, whereas self-control does not play a signifi cant role for the prediction of intrinsic teacher motivation. (DIPF/Orig.)Der Artikel befasst sich mit personen- und umweltbezogenen Bedingungen der intrinsischen Lehrermotivation. Das Thema Lehrermotivation und insbesondere die Analyse ihrer Bedingungen waren bisher kaum Gegenstand der empirischen Forschung. Vor allem die Frage, inwiefern auch relativ stabile Persönlichkeitsdispositionen die intrinsische Lehrermotivation vorhersagen können, ist wenig erforscht. Auf der Basis der Selbstbestimmungstheorie [...] und der Persönlichkeits-System-Interaktionstheorie [...] wird untersucht, inwiefern die Unterstützung der grundlegenden psychologischen Bedürfnisse nach Autonomie, Kompetenz und sozialer Einbindung sowie die der PSI Theorie zugrundeliegenden Persönlichkeitsaspekte Selbstregulation (Aufrechterhaltung des Selbst) und Selbstkontrolle (Aufrechterhaltung von Zielen) die intrinsische Motivation von Lehrpersonen vorhersagen können. Es wurden 136 Lehrpersonen der Sekundarstufe II mittels Fragebogen befragt. Analysen auf Basis von Strukturgleichungsmodellen zeigen, dass die Selbstregulation als Mediator zwischen der wahrgenommenen Basic Needs-Unterstützung und der intrinsischen Motivation fungiert. Im Gegensatz dazu erwies sich Selbstkontrolle als ungeeigneter Prädiktor für die intrinsische Motivation von Lehrerinnen und Lehrern. (DIPF/Orig.

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices in Europe

© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold

Intraoperative transfusion practices and perioperative outcome in the European elderly: A secondary analysis of the observational ETPOS study

The demographic development suggests a dramatic growth in the number of elderly patients undergoing surgery in Europe. Most red blood cell transfusions (RBCT) are administered to older people, but little is known about perioperative transfusion practices in this population. In this secondary analysis of the prospective observational multicentre European Transfusion Practice and Outcome Study (ETPOS), we specifically evaluated intraoperative transfusion practices and the related outcomes of 3149 patients aged 65 years and older. Enrolled patients underwent elective surgery in 123 European hospitals, received at least one RBCT intraoperatively and were followed up for 30 days maximum. The mean haemoglobin value at the beginning of surgery was 108 (21) g/l, 84 (15) g/l before transfusion and 101 (16) g/l at the end of surgery. A median of 2 [1–2] units of RBCT were administered. Mostly, more than one transfusion trigger was present, with physiological triggers being preeminent. We revealed a descriptive association between each intraoperatively administered RBCT and mortality and discharge respectively, within the first 10 postoperative days but not thereafter. In our unadjusted model the hazard ratio (HR) for mortality was 1.11 (95% CI: 1.08–1.15) and the HR for discharge was 0.78 (95% CI: 0.74–0.83). After adjustment for several variables, such as age, preoperative haemoglobin and blood loss, the HR for mortality was 1.10 (95% CI: 1.05–1.15) and HR for discharge was 0.82 (95% CI: 0.78–0.87). Preoperative anaemia in European elderly surgical patients is undertreated. Various triggers seem to support the decision for RBCT. A closer monitoring of elderly patients receiving intraoperative RBCT for the first 10 postoperative days might be justifiable. Further research on the causal relationship between RBCT and outcomes and on optimal transfusion strategies in the elderly population is warranted. A thorough analysis of different time periods within the first 30 postoperative days is recommended