[Made open: The state of international evidence-based research on Open Educational Resources (OER)]. / Offen gemacht: Der Stand der internationalen evidenzbasierten Forschung zu Open Educational Resources (OER).

Open Educational Resources (OER) are an integral part of the debate about the digitization of education. This article reviews the state of international empirical research on OER to identify possible desiderata for a future research agenda. A systematic mapping approach is used to map the empirical English-speaking research landscape. The results reveal that research concentrates on the higher education sector while only a few studies are available for the school sector. In terms of research methodology, quantitative studies are prevalent, mostly using surveys. The research interest of the studies lies in the perception of OER and their adoption and usage in educational practices. Open Textbooks and their comparative cost advantages or qualitative comparability with traditional educational material is a newly emerging field. Research gaps exist regarding usability and user-friendliness of OER repositories. Addressing these gaps could support the numerous initiatives of the German federal states to establish OER portals. Further research gaps were identified regarding the effects of the use of OER on pedagogical approaches and established educational practices.

Electronic Transitions in Different Redox States of Trinuclear 5,6,11,12,17,18-Hexaazatrinaphthylene-Bridged Titanium Complexes: Spectroelectrochemistry and Quantum Chemistry.

Multinuclear transition metal complexes bridged by ligands with extended π-electronic systems show a variety of complex electronic transitions and electron transfer reactions. While a systematic understanding of the photochemistry and electrochemistry has been attained for binuclear complexes, much less is known about trinuclear complexes such as hexaphenyl-5,6,11,12,17,18-hexaazatrinaphthylene-tristitanocene [(Cp2 Ti)3 HATN(Ph)6 ]. The voltammogram of [(Cp2 Ti)3 HATN(Ph)6 ] shows six oxidation and three reduction waves. Solution spectra of [(Cp2 Ti)3 HATN(Ph)6 ] and of the electrochemically formed oxidation products show electronic transitions in the UV, visible and the NIR ranges. Density functional theory (DFT) and linear response time-dependent DFT show that the three formally titanium(II) centers transfer an electron to the HATN ligand in the ground state. The optically excited transitions occur exclusively between ligand-centered orbitals. The charged titanium centers only provide an electrostatic frame to the extended π-electronic system. Complete active self-consistent field (CASSCF) calculation on a structurally simplified model compound, which considers the multi-reference character imposed by the three titanium centers, can provide an interpretation of the experimentally observed temperature-dependent magnetic behavior of the different redox states of the title compound in full consistency with the interpretation of the electronic spectra.

Synthesis, Crystal Structures, and Magnetic and Electrochemical Properties of Highly Phenyl Substituted Trinuclear 5,6,11,12,17,18-Hexaazatrinaphthylene (HATNPh6)-Bridged Titanium Complexes.

Trinuclear titanium complexes coordinated by one ligand with three coordination sites have shown properties of mixed valency and a high number of reversible redox steps. Herein we report on the hexaphenyl-substituted derivative (Cp2Ti)3(µ3-HATNPh6) (2). On reaction of 2 with the ferrocenium salt [Cp2Fe]BF4, the cationic complexes [(Cp2Ti)3(µ3-HATNPh6)] n+ ( n = 1-3; 3-5) become available in a selective way. Cyclic voltammograms show 10 reversible redox states of the trinuclear species 2 without decomposition. In order to classify the degree of electronic communication between the titanium centers, comproportionation constants Kc, IVCT bands in NIR spectra, and magnetic measurements were analyzed. These parameters show strong coupling effects between the titanium centers but no full delocalization. In addition, single-crystal X-ray analysis of the neutral complex 2 and its oxidation products (1+ (3), 2+ (4), and 3+ (5)) revealed the geometric structure of the molecule in the solid state. For the cationic species anion-π interactions between the electron-deficient central ring of the HATNPh6 ligand and BF4- counterions were found.

[No registration of complications for implants used in gynaecological surgery]. / Ingen registrering af komplikationer til implantater ved gynaekologiske operationer.

INTRODUCTION: In recent years, many new surgical implants (biological and synthetic) for female urinary incontinence and pelvic organ prolapse (POP) surgery have been launched in Denmark. In the literature, complications have been reported in up to 40% of cases depending on the type of operation, 2-5% as serious complications. An implant can achieve CE-marking if it seems likely that it is substantially equivalent to an implant already on the market. Thus implants can be launched without clinical data. MATERIAL AND METHODS: Correspondence or contact by phone to: 1) The Danish Ministry of Public Health, 2) The Danish National Board of Health (DB), 3) Danish Medicines Agency (DM), 4) Dansk Standard, and 5) companies/manufacturers in order to establish who has the responsibility for surveillance and approval of such medical devices in Denmark. Furthermore, we established how many surgical implants for urine incontinence and POP surgery are currently on the Danish market. RESULTS: Twenty-five different surgical devices are currently being marketed in Denmark. DM has the responsibility to collect, register and to act on complications. DM had four reports of complications in the period 2001-2006. Both the surgeon and the manufacturer/company have a duty to report complications. CONCLUSION: The Danish medical authorities have no records showing which surgical implants have been launched on the Danish market. There is an urgent need to establish a reliable registry which can facilitate surveillance of new surgical implants in order to improve patient safety. There is also a considerable need to increase the requirements, including the requirements for clinical data, before new surgical implants may be launched.

[Surgical treatment of female urinary incontinence]. / Kirurgisk behandling af urininkontinens hos kvinder.

INTRODUCTION: During the last decade, minimal invasive procedures have been introduced for treatment of urinary incontinence (UI) in women leading to shorter hospitalisation and fewer complications. The aim of this study was to outline clinical practice and attitudes among Danish UI surgeons. MATERIAL AND METHODS: Surgeons performing UI procedures were identified and mailed a questionnaire in 2007 concerning 2006. Questions included specialisation, number of procedures, type of surgery, complications and attitude towards learning surgery and maintaining a sufficient level of routine. RESULTS: In total, 94 operating gynaecologists and urologists were identified, 63 responded (71%) of whom 49 (78%) performed UI surgery. UI surgeons were gynaecologists 43 (88%) of these 24 (49%) were urogynecologists (working more than 50% with urogynecology) and five (10%) urologists. Tension-free Vaginal Tape (TVT) was the preferred sling in 2006. A total of 20 (47%) UI surgeons used only TVT, seven (17%) only transobturator slings (TOS) and 15 (36%) both TVT and TOS. Only 11 (24%) performed > 25 TVT per year and 11 (27%) performed > 25 TOS per year. In all, UI surgeons had experience with ten different slings. This study did not allow for a quantitative assessment of complications. The attitude was that 10-25 operations are needed to learn the procedure, and that > 10 operations per year are needed to maintain a sufficient level of routine. CONCLUSION: Practice and attitudes among urinary incontinence surgeons vary considerably and there is a lack of consensus. Many UI surgeons perform few operations with different techniques.

A Danish national survey of women operated with mid-urethral slings in 2001.

OBJECTIVE: To perform a national survey on self-reported cure, satisfaction and complications four years after mid-urethral sling (MUS) for urinary stress incontinence in Danish women operated in 2001. DESIGN: A postal questionnaire survey. POPULATION: All Danish women who received an MUS operation in 2001 extracted from the Danish National Patient Register. METHODS: The women received a validated postal questionnaire in 2005. The questionnaire included questions about subjective cure, satisfaction, complications and a Danish version of International Consultation on Incontinence Questionnaire-Short Form. The study was carried out in cooperation with the Danish National Board of Health. RESULTS: A total of 335 (92%) women responded to the questionnaire, among whom 105 (32%) felt completely cured, 119 (36%) were much improved, 55 (17%) were improved and 48 (15%) unchanged or worse. Cure rate varied between departments from 0% to 67%. Low-volume departments (<10 operations/year) had a significantly (p = 0.05) lower cure rate compared to the department with a higher volume. Altogether, 238 (73%) women were very satisfied with their operation. Self-reported bladder emptying difficulties were reported by 103 (32%) and the need for clean intermittent catherization (CIC) at any stage was reported by 21 (7%). No woman was still performing CIC. Of the women, 126 (42%) had made contact with the healthcare system because of their operation after discharge from hospital. CONCLUSIONS: Long-term outcome of MUS operations in Denmark in terms of cure, satisfaction and complication rates seems comparable to international results; however, the decentralized organization with many low-volume departments seems inappropriate.

[Urinary incontinence surgery in Denmark 2001-2003]. / Urininkontinenskirurgi i Danmark 2001-2003.

INTRODUCTION: The centralisation of surgical activity is an important aspect of the ongoing planning of the Danish Healthcare System. Knowledge of the actual status is crucial in the process of decision. In this article incontinence surgery in Denmark, including the frequency of complications, during a three year period is outlined. MATERIAL AND METHODS: This was a retrospective study, where data were extracted from the Danish National Patient Register (LPR) from 2001 to 2003. Data were supported by discharge letters and chart operation descriptions for women readmitted within 30 days after primary operation or if the hospital stays were prolonged. RESULTS: In total 2678 incontinence operations were performed in the period by 51 different departments. Seven departments carried out 51% of all the procedures, while 33 departments carried out 14% of all the procedures. The frequency of postoperative complications was 33.9% after an abdominal procedure, 10.8% after a Tension free Vaginal Tape (TVT) like procedure and 2.3% after urethral injection therapy. For abdominal procedures, "high volume" departments (> 45 operations/3 years) had significantly fewer complications compared to "low volume" departments (<15 operations/3 years), while no difference was found in the TVT-like group. Registration of complications and reoperations was incomplete and incorrect, especially in the TVT-like group. Mortality within 30 days was 0. CONCLUSION: This study shows a decentralised organisation of surgical incontinence activity in Denmark. Many departments carried out very few operations. There is a need for better registration, especially of TVT slings, and there is a need to reliably monitor the quality of incontinence surgery in Denmark. Surgical incontinence activity should be more centralised.

[Bilateral suprapubic abscessses five years after incontinence surgery]. / Bilateral suprapubisk abscesdannelse fem år efter inkontinensoperation.

This report presents a case of vaginal erosion and bilateral suprabupic abscesses five years after insertion of an intravaginal slingplasty (IVS) midurethral incontinence sling in a 53-year-old female patient. Partial removal was insufficient. After complete removal, the patient achieved full recovery. As opposed to the macroporous types (e.g. tension-free vaginal tape), the microporous structure of the IVS-sling causes a higher rate of erosion and infection. Complete sling removal is important in case of IVS-complications. The monitoring of complications related to new medical devices is insufficient in Denmark.

Does the tension-free vaginal tape procedure (TVT) affect the voiding function over time? Pressure-flow studies 1 year and 3(1/2) years after TVT.

AIM: The aim was to evaluate the voiding function over time after the TVT procedure for stress incontinence. MATERIALS AND METHODS: Thirty-eight women with urodynamic stress urinary incontinence were included in the study. For voiding function assessment the patients were asked if voiding had changed postoperatively, and objectively uroflowmetry, residual urine measurement and pressure-flow were performed preoperatively, 1 year and 3(1/2) years postoperatively. RESULTS: At 1/3(1/2) years follow-up 87%/69% were subjectively cured and 13%/26% improved, respectively. The objective cure rate was 89%/74%. Subjectively 77%/63% of the patients felt an altered voiding function towards more difficult voiding one and 3(1/2) years after surgery, respectively. Objectively all the uroflowmetry variables deteriorated and residual urine volume increased over time although the changes were not statistically significant between the 1 and 3(1/2) years follow-up. Pressure-flow variables were essentially unchanged. CONCLUSION: The changes in voiding function after a TVT do not reverse over time. This may imply a potential risk of development of clinically important impaired emptying function.

Erosion, defective healing and extrusion after tension-free urethropexy for the treatment of stress urinary incontinence.

A case-control study was performed in two departments performing tension-free urethropexy for the treatment of stress urinary incontinence. During a period of 4.5 years, 127 cases of tension-free vaginal tape operations (TVT) and 42 cases of intravaginal slingplasty (IVS) were performed. In the TVT group one case of urethral erosion was observed, but in the IVS group six cases of defective healing, erosion or extrusion were observed. It is considered that the complications might be due to the multifilamentous nature of the IVS tape in contrast to the monofilamentous nature of the TVT tape.

Should measurement of maximum urinary flow rate and residual urine volume be a part of a "minimal care" assessment programme in female incontinence?

OBJECTIVE: The aim of this study was to evaluate the value of routine measurements of urinary flow rate and residual urine volume as a part of a "minimal care" assessment programme for women with urinary incontinence in detecting clinical significant bladder emptying problems. MATERIAL AND METHODS: Four hundred and eight women were examined and treated in an open-access, interdisciplinary incontinence clinic. A standardized programme for investigation and primarily non-surgical treatment of incontinence was applied. RESULTS: Of the 408 women 43% reported subjectively incomplete bladder emptying. Twenty-six per cent had a maximum flow rate less than 15 ml/s, but only 4% at a voided volume > or =200 ml. Residual urine more than 149 ml was found in 6%. Two women had chronic retention with overflow incontinence. Both had typical symptoms with continuous leakage, stranguria and chronic cystitis. Another woman had an urethral stricture with massive bladder emptying symptoms. In the remaining 172 women with symptoms suggesting bladder emptying problems, all but 3 were managed by triple voiding and timed micturition. In these 3 patients, who also had chronic cystitis, the treatment was supplemented with clean intermittent self-catheterization. CONCLUSION: The few women (6 (1.5%)) in whom measurements of urinary flow rate and residual urine volume had a clinical therapeutic consequence, cannot justify these measurements to be routine in a "minimal care" programme for assessment of primary, uncomplicated female urinary incontinence. Thus, primary health care providers can assess women based on simple guidelines without expensive equipment for assessment of urine flow rate and residual urine.

Does the tension-free vaginal tape procedure affect the voiding phase? Pressure-flow studies before and 1 year after surgery.

OBJECTIVE: To evaluate the voiding phase before and 1 year after surgery in women who underwent a tension-free vaginal tape (TVT) procedure for stress incontinence. PATIENTS AND METHODS: The study comprised 45 women with genuine stress urinary incontinence. To assess the voiding phase, patients were asked if their voiding had changed after surgery, and objectively the uroflowmetry, residual urine measurements and pressure-flow data were compared. RESULTS: At 1 year after surgery 39 women (87%) were subjectively cured and six (13%) improved. The objective cure rate was 88%; the pad-test leakage and the number of leakage episodes decreased significantly after surgery. Subjectively, 78% of the patients reported that the voiding phase had become more difficult, and the spontaneous flow curve changed to a more obstructive pattern in 40%, with the mean urinary peak flow rate (Q(max)), the corrected Q(max) and the mean average flow rate decreasing significantly. The residual urine volume increased significantly, although no patient had volumes of > 25% of their bladder capacity. During the pressure-flow study the Q(max) decreased and the urethral resistance factor increased significantly. However, only one patient could be classified as obstructed. Two patients had clinical problems and used self-catheterization once daily 1 year after surgery. CONCLUSION: There were subjective and objective changes in the voiding phase 1 year after the TVT procedure. The significance of these findings remains to be determined. Longitudinal studies are warranted to clarify whether the patients at risk can be characterized from subjective and objective findings.