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Design Science Research (DSR) has become a widespread paradigm in the Information Systems (IS) discipline to design and evaluate novel artifacts for relevant problems in a scientifically rigorous manner. With its potential to complement the traditional IS curriculum, DSR education is gaining popularity in academia, despite still being in its infancy. Our contribution applies DSR for designing and evaluating a DSR teaching framework (TF) derived from reused and expanded design principles from literature. Our approach mediates the paradigm's methodical versatility to master's students, empowering them to evaluate and create their own DSR projects interactively. We evaluated our DSR TF in a workshop with DSR educators from three countries and six universities to discuss its applicability for reuse. Additionally, we surveyed former course participants to gather their feedback and reflect on their experiences.

Pedagogical conversational agents (PCAs) are an innovative way to help learners improve their academic performance via intelligent dialog systems. However, PCAs have not yet reached their full potential. They often fail because users perceive conversations with them as not engaging. Enriching them with game-based approaches could contribute to mitigating this issue. One could enrich a PCA with game-based approaches by gamifying it to foster positive effects, such as fun and motivation, or by integrating it into a game-based learning (GBL) environment to promote effects such as social presence and enable individual learning support. We summarize PCAs that are combined with game-based approaches under the novel term "game-inspired PCAs". We conducted a systematic literature review on this topic, as previous literature reviews on PCAs either have not combined the topics of PCAs and GBL or have done so to a limited extent only. We analyzed the literature regarding the existing design knowledge base, the game elements used, the thematic areas and target groups, the PCA roles and types, the extent of artificial intelligence (AI) usage, and opportunities for adaptation. We reduced the initial 3,034 records to 50 fully coded papers, from which we derived a morphological box and revealed current research streams and future research recommendations. Overall, our results show that the topic offers promising application potential but that scholars and practitioners have not yet considered it holistically. For instance, we found that researchers have rarely provided prescriptive design knowledge, have not sufficiently combined game elements, and have seldom used AI algorithms as well as intelligent possibilities of user adaptation in PCA development. Furthermore, researchers have scarcely considered certain target groups, thematic areas, and PCA roles. Consequently, our paper contributes to research and practice by addressing research gaps and structuring the existing knowledge base. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To compare extracorporeal shock wave therapy combined with oral medication and an exercise program vs sham treatment with medication and exercise for the treatment of chronic low back pain (CLBP). Randomized controlled trial. Outpatient clinic at a university hospital. Eligibility criteria were age older than 18 years and duration of CLBP exceeding 3 months. Exclusion criteria were concurrent treatment or history of surgery for CLBP, cancer, fractures, infections, and disk degeneration. The intervention group received extracorporeal shock wave therapy once a week for 4 weeks along with oral medications and an exercise program. The control group received sham extracorporeal shock wave therapy along with oral medications and an exercise program. Visual analog scale and Oswestry Disability Index (ODI) were used to assess pain and disability at baseline and after 3 months. The pain score in the intervention group (N=16) was 6.6 at baseline and 3.0 after 1 month (P <.0001) and 1.8 after 3 months (P <.0001). In the control group (N=16), the pain score was 6.8 at baseline, 4.6 after 1 month (P <.0001), and 1.1 after 3 months (P <.0001). ODI scores decreased significantly in both groups compared with baseline values (first month: P <.001, third month: P <.05). The mean ODI score did not differ significantly between the groups (P =.942). Extracorporeal shock wave therapy combined with oral medication and exercise was safe and effective in the short-term treatment of chronic low back pain. • Extracorporeal shockwave therapy significantly alleviated the pain and disability score in patients with low back pain within the first month after the intervention compared with the control group. • The effect of extracorporeal shockwave therapy to relieve the pain and disability in patients with low back pain was similar to the control group. • Extracorporeal shockwave therapy would probably be useful to control the pain and disability in a short period of time. [Display omitted] [ABSTRACT FROM AUTHOR]

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief. The article includes material that had already appeared in de Oliveira RF, da Silva AC, Simoes A, Youssef MN, de Freitas PM. Laser Therapy in the Treatment of Paresthesia: A Retrospective Study of 125 Clinical Cases. Photomed Laser Surg. 2015 Aug; 33(8)415-23. doi: 10.1089/pho.2015.38888. PMID:26226172 in the journal Photomedicine and Laser Surgery by Mary Ann Liebert Publishing. Any re-use of any material should be appropriately cited and published with permission of any relevant copyright owner. As such this article represents a misuse of the scientific publishing system. Apologies are offered to readers of the journal that this was not detected during the submission process. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: The aim of the present study was to evaluate the effect of applying electroencephalogram (EEG) biofeedback (neurobiofeedback) or electromyographic (EMG) biofeedback to conventional occupational therapy (OT) on improving hand function in stroke patients. Methods: This study was designed as a preliminary clinical trial. Thirty patients with stroke were entered the study. Hand function was evaluated by Jebsen Hand Function Test pre and post intervention. Patients were allocated to 3 intervention cohorts: (1) OT, (2) OT plus EMG-biofeedback therapy, and (3) OT plus neurofeedback therapy. All patients received 10 sessions of conventional OT. Patients in cohorts 2 and 3 also received EMG-biofeedback and neurofeedback therapy, respectively. EMG-biofeedback therapy was performed to strengthen the abductor pollicis brevis (APB) muscle. Neurofeedback training was aimed at enhancing sensorimotor rhythm after mental motor imagery. Results: Hand function was improved significantly in the 3 groups. The spectral power density of the sensorimotor rhythm band in the neurofeedback group increased after mental motor imagery. Maximum and mean contraction values of electrical activities of the APB muscle during voluntary contraction increased significantly after EMG-biofeedback training. Conclusion: Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy. [ABSTRACT FROM AUTHOR]

Objective: The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay., Background: The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD)., Methods: Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included. The datasets were retrospectively collected from a central database. The effects of individual ERAS items and compliance on morbidity and hospital stay were assessed by uni- and multivariable analyses., Results: In total, 594 patients who underwent PD (44.8%), distal pancreatectomy (14.6%), total pancreatectomy (17.8%), or other pancreatic resections (22.7%) were included. Of these, 90 patients (15.2%) achieved a high overall ERAS compliance of ≥70%. High compliance was associated with significantly less complications (Clavien-Dindo ≥ 3a), reduced 30-day mortality, and a shorter hospital stay. Early mobilization on the first postoperative day (POD1), restrictive intravenous fluid administration, and timely removal of urinary catheters were significant multivariable predictors for lower morbidity. Early mobilization on POD1 also correlated with reduced morbidity in the subcohort of PD cases., Conclusions: The pancreatic ERAS protocol can be sustainably implemented and applied to both, PD and non-PD cases. A high level of compliance with the ERAS protocol after pancreatic resections correlated with improved outcomes but was achieved by less than one-fifth of patients. Early mobilization on POD1 and restrictive fluid management were key indicators for optimized short-term outcomes., Competing Interests: Disclosure: The authors declare that they have nothing to disclose., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

The transformation of time-bound and procedure-oriented specialist medical postgraduate training towards a competency-based approach (competency-based medical education, CBME) has been demanded for several years. Many frameworks, like the CANMEDs (Canadian Medical Education Directives for Specialists) describe competencies that should be acquired by each physician. In Germany, the medical council has recently obligated a competency-based postgraduate training. Although the idea of CBME emphasizes the learning process at the working place, CBME has also been criticized to be too theoretical and detached from the clinical working practice. To close this gap, the concept of Entrustable Professional Activities (EPA) has been introduced. An EPA describes concrete clinical tasks that are successively entrusted to the trainee. The decision to entrust a task is supported by the sum of workplace-based assessments.Sustainable implementation of competency-based training requires close collaboration among all involved individuals and institutions. Furthermore, continuous feedback and open dialogue are crucial for identifying challenges and areas for improvement. The success of CBME hinges on the collective effort of all stakeholders to create a framework to enhance specialty training and an overall advancement in the field. This cooperative approach is essential to successfully translate the theoretical foundations of competency-based teaching into clinical practice and ensure high-quality specialty training., Competing Interests: Parisa Moll-Khosrawi ist Entwicklerin und Initiatorin des im Artikel beschriebenen EPA-basierten Logbuchs., (Thieme. All rights reserved.)

Background: Finger-cuff methods allow noninvasive continuous arterial pressure monitoring. This study aimed to determine whether continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery. Specifically, this study tested the hypotheses that continuous finger-cuff-compared to intermittent oscillometric-arterial pressure monitoring helps clinicians reduce the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia and the time-weighted average mean arterial pressure less than 65 mmHg during noncardiac surgery., Methods: In this single-center trial, 242 noncardiac surgery patients were randomized to unblinded continuous finger-cuff arterial pressure monitoring or to intermittent oscillometric arterial pressure monitoring (with blinded continuous finger-cuff arterial pressure monitoring). The first of two hierarchical primary endpoints was the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia; the second primary endpoint was the time-weighted average mean arterial pressure less than 65 mmHg during surgery., Results: Within 15 min after starting induction of anesthesia, the median (interquartile range) area under a mean arterial pressure of 65 mmHg was 7 (0, 24) mmHg × min in 109 patients assigned to continuous finger-cuff monitoring versus 19 (0.3, 60) mmHg × min in 113 patients assigned to intermittent oscillometric monitoring (P = 0.004; estimated location shift: -6 [95% CI: -15 to -0.3] mmHg × min). During surgery, the median (interquartile range) time-weighted average mean arterial pressure less than 65 mmHg was 0.04 (0, 0.27) mmHg in 112 patients assigned to continuous finger-cuff monitoring and 0.40 (0.03, 1.74) mmHg in 115 patients assigned to intermittent oscillometric monitoring (P < 0.001; estimated location shift: -0.17 [95% CI: -0.41 to -0.05] mmHg)., Conclusions: Continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery compared to intermittent oscillometric arterial pressure monitoring., (Copyright © 2023 American Society of Anesthesiologists. All Rights Reserved.)

Entrustable Professional Activities (EPA) are specialty specific tasks or responsibilities, combining the clinical workplace and the long-demanded competency-based medical education. The first step to transform time-based into EPA-based training is to reach consensus on core EPAs that describe sufficiently the workplace. We aimed to present a nationally validated EPA-based curriculum for postgraduate training in anaesthesiology. Using a predefined and validated list of EPAs, we applied a Delphi consensus approach, involving all German chair directors of anaesthesiology. We then conducted a subsequent qualitative analysis. Thirty-four chair directors participated in the Delphi survey (77% response) and twenty-five completed all the questions (56% overall response). Reflected by the intra-class-correlation, the consensus on the importance (ICC: 0.781, 95% CI [0.671, 0.868]) and the year of entrustment (ICC: 0.973, 95% CI [0.959, 0.984]) of each EPA reached high levels of agreement among the chair directors. The comparison of data assessed in the preceding validation and present study showed excellent and good levels of agreement (ICC entrustment: 0.955, 95% CI [0.902, 0.978]; ICC importance: 0.671, 95% CI [-0.204, 0.888]). The adaptation process, based on the qualitative analysis, resulted in a final set of 34 EPAs. We present an elaborate, fully described and nationally validated EPA-based curriculum, reflecting a broad consensus among different stakeholders of anaesthesiology. We hereby provide a further step towards competency-based postgraduate anaesthesiology training., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ganzhorn et al. This 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.)

Non-technical skills (NTS) in medical care are essential to ensure patient safety. Focussing on applicants' NTS during medical school admission could be a promising approach to ensure that future physicians master NTS at a high level. Next to pre-university educational attainment, many selection tests have been developed worldwide to facilitate and standardise the selection process of medical students. The predictive validity of these tests regarding NTS performance in clinical settings has not been investigated (yet). Therefore, we explored the predictive validities and prognosis of the Hamburg MMI (HAM-Int), HAM-Nat, PEA, and waiting as well as other quota (as example) designated by the Federal Armed Forces) for NTS performance in clinical emergency medicine training of medical students. During 2017 and 2020, N = 729 second, third, and fourth year students were enrolled within the study. The mean age of participants was 26.68 years (SD 3.96) and 49% were female students. NTS of these students were assessed during simulation scenarios of emergency training with a validated rating tool. Students admitted via waiting quota and designated by the Armed Forces performed significantly better than students admitted by excellent PEA ( p = 0.026). Non-EU students performed significantly inferior ( p = 0.003). Our findings provide further insight to explain how and if admission to medical school could predict NTS performance of further physicians.

Background: Hypotension during induction of anaesthesia is associated with organ injury. Continuous arterial pressure monitoring might help reduce hypotension. We tested the hypothesis that continuous intra-arterial compared with intermittent oscillometric arterial pressure monitoring reduces hypotension during induction of anaesthesia in noncardiac surgery patients., Methods: In this single-centre randomised trial, 242 noncardiac surgery patients in whom intra-arterial arterial pressure monitoring was planned were randomised to unblinded continuous intra-arterial or to intermittent oscillometric arterial pressure monitoring (with blinded intra-arterial arterial pressure monitoring) during induction of anaesthesia. The primary endpoint was the area under a mean arterial pressure (MAP) of 65 mm Hg within the first 15 min of induction of anaesthesia. Secondary endpoints included areas under MAP values of 60, 50, and 40 mm Hg and durations of MAP values <65, <60, <50, and <40 mm Hg., Results: There were 224 subjects available for analysis. The median (25th-75th percentile) area under a MAP of 65 mm Hg was 15 (2-36) mm Hg • min in subjects assigned to continuous intra-arterial monitoring and 46 (7-111) mm Hg • min in subjects assigned to intermittent oscillometric monitoring (P<0.001). Subjects assigned to continuous intra-arterial monitoring had smaller areas under MAP values of 60, 50, and 40 mm Hg and shorter durations of MAP values <65, <60, <50, and <40 mm Hg than subjects assigned to intermittent oscillometric monitoring., Conclusion: Continuous intra-arterial arterial pressure monitoring reduces hypotension during induction of anaesthesia compared with intermittent oscillometric arterial pressure monitoring in noncardiac surgery patients. In patients for whom an arterial catheter is planned, clinicians might therefore consider inserting the arterial catheter before rather than after induction of anaesthesia., Clinical Trials Registration: NCT04894019., (Copyright © 2022 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Objectives: To assess the effects of simulation-based education on medical students' motivation and to compare these effects with the motivational effects of a classical teaching approach (seminar)., Methods: In this cross-sectional study, motivational qualities of 164 3rd year medical students, who participated in four mandatory simulation-based training and two seminars of the department of anaesthesiology, were assessed. Comparative analysis was made to determine differences and changes of motivation towards participating in each teaching unit and each teaching format, using a one-way analysis of variance and unpaired t-tests., Results: The different motivational qualities, as well as the computed levels of autonomous and controlled motivation of students towards participating in each of the six teaching units and each teaching format did not differ significantly (F (5, 839) = 0.66, p = 0.657; F (5, 839) = 0.29, p = 0.920; (t (843) = - 0.72, p = 0.471; t (843) = -0.17, p = 0.868). Students` motivation, particularly autonomous motivation, did not enhance after participating in the first SBME, (t (264) = 1.035, p = 0.301), after participating in the second SBME, (t (254) = -0.055, p = 0.956), or after participating in the third training (t (250) = -0.881, p = 0.379)., Conclusions: Simulation-based medical education provides a valuable teaching approach but, in this study, this teaching approach did not enhance nor stimulate student motivation. Therefore, simulation-based medical education equals classical teaching approaches regarding student motivation. Further investigations are needed to identify how simulation-based medical education could enhance medical students' motivation.

Studies applying the self-determination theory have shown that intrinsic motivation and autonomous regulation lead to job satisfaction and to better job performance. What has not been worked out clearly yet are the effects of extrinsic motivation and controlled regulation on affect, job performance and job satisfaction. However, it has been described that controlled regulation is often necessary for mundane tasks. In anaesthesiology, routine daily tasks can be perceived as mundane by those who have achieved a certain level of training (e.g., consultants). Therefore, it was hypothesised that consultants have high expressions of all motivational qualities. Furthermore, it was hypothesised that job satisfaction of anaesthesiologists is correlated with autonomous motivation. The hypotheses were tested in a cross-sectional study design within a group of anaesthesiologists. The study participants reported the same pattern throughout the motivational continuum. Consultants reported the highest levels of all motivational qualities, including controlled regulation, as well as the highest levels of job satisfaction. Junior residents reported high levels of amotivation and extrinsic regulation. The lowest levels of identified regulation and job satisfaction were reported by the group of attendings. Job satisfaction was positively correlated with intrinsic motivation and negatively correlated with amotivation. Therefore, our findings from the field of anaesthesiology show that the expressions of high levels of controlled regulation might be necessary for specialists to engage in mundane daily tasks. Intrinsic motivation and autonomous regulation are necessary for job satisfaction and the presence of controlled regulation and extrinsic behavioural regulation have no declining effects. Furthermore, the decrease of amotivation will lead to enhanced job satisfaction and the resulting consequences will be extensive. Junior residents need to be supported with the aim to enhance their feeling of autonomy and competence in order to decrease amotivation and to foster autonomous regulation and hence to increase job satisfaction and well-being. Further special focus should be on attendings to counteract their lacking identification with the job. Hereby, the provision of feedback and professional perspectives might foster the process of re-identification.

Background: Postgraduate training curricula should not be based on time-spans or predefined numbers of performed procedures. One approach to link competencies to clinical tasks is the concept of Entrustable Professional Activities (EPA). The goal of this study was the definition, ranking and validation of EPAs for anaesthesiology postgraduate training and the creation of an anaesthesiologic core curriculum. Methods: Anaesthesiologists of different levels of training participated in the study (single-center, cross-sectional) . First, an expert group defined a preliminary list of EPAs. Then a first Delphi round (n= 47 participants) was applied to identify daily anaesthesiology tasks with the goal to define EPAs. From the first Delphi round a new set of EPAs was defined, using the template and mapping method. Through an alignment process, conducted by the expert group, the preliminary EPAs and the new set of EPAs from the first Delphi round were summarised into a new list of EPAs. This list was presented to the study participants in a second Delphi round (n=80 participants), with the goal to validate and rank each EPA and to define the year of entrustment. For this purpose, participants were asked in the second Delphi round if each EPA should be included into an anaesthesiology core curriculum and in which year of training entrustment should take place. Furthermore, they were asked to rank each EPA on a numeric scale, defining its importance. From this numeric scale, the content validity index (CVI) for each EPA was calculated. Consensus of the results from the second Delphi round was calculated, using the one-way random effects model to calculate Intra-Class-Correlations (ICC). Percentages of agreement among the whole set of EPAs of this study and a previously published set of EPAs were computed. Results: A core-curriculum comprising of 39 EPAs was developed. The EPAs were subdivided into superior/high and inferior/low scoring EPAs, reflecting their importance and were mapped to the year of entrustment. The results reached high consensus among the different participating anaesthesiologist groups (overall agreement was 0.96 for the CVI of each EPA and 0.83 for the year in which the EPAs should be entrusted). Agreement with the previously defined set of EPAs was 73.3%. Conclusion: This study provides a further step in transforming postgraduate anaesthesiology training into a more contemporary approach. Other studies are necessary to complete and amend the presented core curriculum of EPA based postgraduate anaesthesiology training., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020 Moll-Khosrawi et al.)

The VEGFR-1 is suggested to promote tumor progression. In the current study we analyzed prevalence and prognostic impact of the VEGFR-1 by immunohistochemistry on a tissue microarray containing more than 3000 prostate cancer specimens. Results were compared to tumor phenotype, ETS-related gene (ERG) status, and biochemical recurrence. Membranous VEGFR-1 expression was detectable in 32.6% of 2669 interpretable cancers and considered strong in 1.7%, moderate in 6.7% and weak in 24.2% of cases. Strong VEGFR-1 expression was associated with TMPRSS2:ERG fusion status as determined by fluorescence in situ hybridization (FISH) and immunohistochemistry (p < 0.0001 each). Elevated VEGFR-1 expression was linked to high Gleason grade and advanced pT stage in TMPRSS2:ERG negative cancers (p = 0.0008 and p = 0.001), while these associations were absent in TMPRSS2:ERG positive cancers. VEGFR-1 expression was also linked to phosphatase and tensin homolog (PTEN) deletions. A comparison with prostate specific antigen (PSA) recurrence revealed that the 1.7% of prostate cancers with the highest VEGFR-1 levels had a strikingly unfavorable prognosis. This could be seen in all cancers, in the subsets of TMPRSS2:ERG positive or negative, PTEN deleted or undeleted carcinomas (p < 0.0001 each). High level VEGFR-1 expression is infrequent in prostate cancer, but identifies a subgroup of aggressive cancers, which may be candidates for anti-VEGFR-1 targeted therapy.