Challenges and conditions for successfully implementing and adopting the telematics infrastructure in German outpatient healthcare: A qualitative study applying the NASSS framework.

Background: Germany's healthcare system provides high-quality, universal health coverage to almost all residents. However, a major challenge lies in the strong separation of healthcare structures, which hinders efficient interprofessional and intersectoral communication and collaboration. The mandatory nationwide implementation of the telematics infrastructure may offer a solution to enhance healthcare professionals' communication and collaboration. Objective: Our study aims to elicit participants' perceptions of and attitudes towards the implementation and usage of the telematics infrastructure in fostering interprofessional communication and collaboration between home-care nursing services and general practitioner practices. Methods: We conducted interviews with seven members of general practitioner practices and 10 in home-care nursing services. Using thematic content analysis, we identified five themes, of which four along with 10 subthemes were integrated into Greenhalgh et al.'s 'nonadoption, abandonment, scale-up, spread and sustainability' framework. Results: Participants recognised the potential of digital technology to enhance interprofessional communication and collaboration. However, this potential largely depended on individual healthcare actors' willingness to seek information, invest and adapt. Attitudes towards the telematics infrastructure varied widely from hopeful confidence to outright rejection. Home-care nursing services generally viewed the telematics infrastructure with optimism, while general practitioners expressed reservations, particularly due to technological disruptions, lack of user-friendliness, and organisational structures. Conclusion: Our findings highlight the potential of digital technology to enhance interprofessional communication. Successful implementation of technological innovations, however, goes beyond technological aspects and involves social, political and organisational processes. Future implementation strategies for such innovations in healthcare should involve users early and ensure clear communication.

Efficacy of Centers of Biomedical Research Excellence (CoBRE) grants to build research capacity in underrepresented states.

Federal funding for research has immediate and long-term economic impact. Since federal research funding is regionally concentrated and not geographically distributed, the benefits are not fully realized in some regions of the country. The Established (previously Experimental) Program to Stimulate Competitive Research (EPSCoR) programs at several agencies, for example, the National Science Foundation, and the Institutional Development Award (IDeA) program at the National Institutes of Health were created to increase competitiveness for funding in states with historically low levels of federal funding. The Centers of Biomedical Research Excellence (CoBRE) award program is a component of the IDeA program. The CoBRE grants support research core facilities to develop research infrastructure. These grants also support the research projects of junior investigators, under the guidance of mentoring teams of senior investigators, to develop human resources at these institutions. Few studies have assessed the effectiveness of these programs. This study examines the investment and outcomes of the CoBRE grants from 2000 through 2022. The maturation of junior investigators into independently funded principal investigators is comparable to other mentoring programs supported by NIH. The investment in research cores resulted in substantial research productivity, measured by publications. Despite the successes of individual investigators and increased research infrastructure and productivity, the geographic distribution of federal and NIH research dollars has not changed. These results will be informative in consideration of policies designed to enhance the geographic distribution of federal research dollars.

Efficacy of Centers of Biomedical Research Excellence (CoBRE) Grants to Build Research Capacity in Underrepresented States.

Federal funding for research has immediate and long-term economic impact. Since federal research funding is regionally concentrated and not geographically distributed, the benefits are not fully realized in some regions of the country. The Established (previously Experimental) Program to Stimulate Competitive Research (EPSCoR) programs at several agencies, e.g. the National Science Foundation, and the Institutional Development Award (IDeA) program at the National Institutes of Health were created to increase competitiveness for funding in states with historically low levels of federal funding. The Centers of Biomedical Research Excellence (CoBRE) award program is a component of the IDeA program. The CoBRE grants support research core facilities to develop research infrastructure. These grants also support the research projects of junior investigators, under the guidance of mentoring teams of senior investigators, to develop human resources at these institutions. Few studies have assessed the effectiveness of these programs. This study examines the investment and outcomes of the CoBRE grants from 2000 through 2022. The maturation of junior investigators into independently funded principal investigators is comparable to other mentoring programs supported by NIH. The investment in research cores resulted in substantial research productivity, measured by publications. Despite the successes of individual investigators and increase research infrastructure and productivity, the geographic distribution of federal and NIH research dollars has not changed. These results will be informative in consideration of policies designed to enhance the geographic distribution of federal research dollars.

[Sociotechnical innovations for caring communities : Conditions for success in participatory and integrative technology development]. / Soziotechnische Innovationen für Sorgegemeinschaften : Gelingensbedingungen für partizipative und integrative Technikentwicklung.

The increasing need for nursing support in the home environment is accompanied by a decline in the willingness and possibilities for family care (among other things, due to social fragmentation and individualization). New forms of social support networks (caring communities) are therefore needed in which professional players collaborate together with informal caregivers and volunteer helpers. In this context, digitalization can be an instrument that can support the design and coordination of care arrangements for older people at the sociospatial level; however, a fundamental prerequisite is that the corresponding technologies are developed in a participatory manner and integrated into existing structures. This means not only that the needs and requirements of future users are comprehensively included in the developmental process but also that they become active co-decision makers. Furthermore, the developed technology should be oriented to established care structures and sociospatial conditions. This conceptual contribution addresses these two requirements and uses a concrete case study from a participatory technology development project to show how sociotechnical innovations for and with caring communities can be developed, implemented and made usable in such a way that they become sustainably effective.

Training doctoral students in critical thinking and experimental design using problem-based learning.

BACKGROUND: Traditionally, doctoral student education in the biomedical sciences relies on didactic coursework to build a foundation of scientific knowledge and an apprenticeship model of training in the laboratory of an established investigator. Recent recommendations for revision of graduate training include the utilization of graduate student competencies to assess progress and the introduction of novel curricula focused on development of skills, rather than accumulation of facts. Evidence demonstrates that active learning approaches are effective. Several facets of active learning are components of problem-based learning (PBL), which is a teaching modality where student learning is self-directed toward solving problems in a relevant context. These concepts were combined and incorporated in creating a new introductory graduate course designed to develop scientific skills (student competencies) in matriculating doctoral students using a PBL format. METHODS: Evaluation of course effectiveness was measured using the principals of the Kirkpatrick Four Level Model of Evaluation. At the end of each course offering, students completed evaluation surveys on the course and instructors to assess their perceptions of training effectiveness. Pre- and post-tests assessing students' proficiency in experimental design were used to measure student learning. RESULTS: The analysis of the outcomes of the course suggests the training is effective in improving experimental design. The course was well received by the students as measured by student evaluations (Kirkpatrick Model Level 1). Improved scores on post-tests indicate that the students learned from the experience (Kirkpatrick Model Level 2). A template is provided for the implementation of similar courses at other institutions. CONCLUSIONS: This problem-based learning course appears effective in training newly matriculated graduate students in the required skills for designing experiments to test specific hypotheses, enhancing student preparation prior to initiation of their dissertation research.

Conceptualizing Interprofessional Digital Communication and Collaboration in Health Care: Protocol for a Scoping Review.

BACKGROUND: Effective communication and collaboration among health professionals are essential prerequisites for patient-centered care. However, interprofessional teams require suitable structures and tools to efficiently use their professional competencies in the service of high-quality care appropriate to the patient's life situation. In this context, digital tools potentially enhance interprofessional communication and collaboration and lead to an organizationally, socially, and ecologically sustainable health care system. However, there is a lack of studies systematically assessing the critical factors for successfully implementing tools for digitally supported interprofessional communication and collaboration in the health care setting. Furthermore, an operationalization of this concept is missing. OBJECTIVE: The aim of the proposed scoping review is to (1) identify factors influencing the development, implementation, and adoption processes of digital tools for interprofessional communication in the health care sector and (2) analyze and synthesize the (implicit) definition, dimensions, and concepts of digitally supported communication and collaboration among health care professionals in the health care setting. Studies focusing on digital communication and collaboration practices among health care professionals, including medical doctors and qualified medical assistants, in any health care setting will be included in this review. METHODS: To address these objectives, an in-depth analysis of heterogeneous studies is needed, which is best achieved through a scoping review. Within this proposed scoping review, which adheres to the Joanna Briggs Institute methodology, 5 databases (SCOPUS, CINAHL, PubMed, Embase, and PsycInfo) will be searched for studies assessing digital communication and collaboration among various health care professionals in different health care settings. Studies focusing on health care providers or patient interaction through digital tools and non-peer-reviewed studies will be excluded. RESULTS: Key characteristics of the studies included will be summarized through descriptive analysis, using diagrams and tables. We will synthesize and map the data and conduct a qualitative in-depth thematic analysis of definitions and dimensions of interprofessional digital communication and collaboration among health care and nursing professionals. CONCLUSIONS: Results from this scoping review may help in establishing digitally supported collaborations between various stakeholders in the health care setting and successfully implementing new forms of interprofessional communication and collaboration. This could facilitate the transition to better coordinated care and encourage the development of digital frameworks. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/45179.

Research productivity and training support for doctoral students in the biological and biomedical sciences.

Training of doctoral students as part of the next generation of the biomedical workforce is essential for sustaining the scientific enterprise in the United States. Training primarily occurs at institutions of higher education, and these trainees comprise an important part of the workforce at these institutions. Federal investment in the support of doctoral students in the biological and biomedical sciences is distributed differently than the distribution of students across different types of institutions, for example, public vs private. Institutions in states that historically receive less federal support for research also receive less support for doctoral student training. Doctorates at different types of institution exhibit little difference in research productivity, with the exception of citations, and subsequent receipt of additional NIH awards. Thus, training outcomes, which are related to the quality of the student and training environment, are similar across different institutions. Research productivity of doctoral students does not correlate with the number of F31s awarded to an institution. Factors that correlate with F31 funding include R01 funding levels and program size. The findings suggest strategies for institutions to increase success at securing F31s and modification of policy to promote more equitable distribution of F31s across institutions.

Introducing conflict resolution and negotiation training into a biomedical sciences graduate curriculum.

BACKGROUND: Analysis of the biomedical workforce and graduate education have produced recommendations for modifications of pre-doctoral training to broadly prepare trainees for wider ranging scientific careers. Development of training in professional skills is widely recommended, but details of implementation are not widely available. In alignment with these recommendations, we have incorporated professional skills training into the biomedical science graduate curriculum at West Virginia University. An important component of the training is developing conflict resolution and negotiation skills. This training will provide useful skills for academic careers, non-academic careers and life situations outside of the workplace. Conflict resolution/negotiation skills are also relevant in managing issues in diversity, equity and inclusivity. We report our experience in developing this component of the training program, provide an overview of the approach to delivery and practice of skills, and provide an analysis of the reception and effectiveness of the training. METHODS: Evaluation of effectiveness of training used the principals of the Kirkpatrick Four Level Model of Evaluation. At the end of the course, students completed a questionnaire about their perceptions of training and were asked how they would respond to different scenarios requiring conflict resolution/negotiation skills. Several months later, students were surveyed to determine if they used some of these skills and/or witnessed situations where these skills would be useful. RESULTS: We report our experience in developing conflict resolution/negotiation training in our graduate curriculum, provide an overview of the approach to delivery and practice of skills, and provide an analysis of the reception and effectiveness of the training. The results suggest this training meets a need and is effective. Importantly, these materials provide a template for others wishing to implement similar training in their curricula. CONCLUSIONS: Conflict resolution and negotiation training meets a need in graduate education. A mixed approach using didactic and interactive components spaced out over time appears to be an effective method of training.

Process Mining of Nursing Routine Data: Cool, but also Useful?

BACKGROUND: Process mining is a promising field of data analytics that is yet to be applied broadly in healthcare. It can streamline the care process, leading to a higher quality of care, increased patient safety and lower costs. OBJECTIVES: To get deeper insights into the emergence and detectability of delirium in a gerontopsychiatric setting. METHODS: We use process mining to create process models from routinely collected, anonymised nursing data from two gerontopsychiatric wards. We analyse these models to get a longitudinal view of the care processes. RESULTS: The process models comprise all activities during patients' stays but are too extensive and challenging to interpret due to the wide variation in care paths. Although the models give insight into frequent paths and activities, they are insufficient to explain the emergence of delirium meaningfully. No apparent difference between stays with or without delirium could be detected. CONCLUSION: Conducting process mining on routinely collected data is easy, but the interpretation of the results was a challenge. We identified four limitations associated with using this data and gave recommendations on adapting it for further analysis.

FastTrack, a strategy to shorten time to degree.

Recent reports express concern about the sustainability of the biomedical research enterprise in its current form. Recurring concerns include the predictability and sustainability of funding for research, regulatory burden and training the next generation in the biomedical workforce. One specific concern is the duration of training periods during pre-doctoral and post-doctoral studies. This article addresses the issue of time-to-degree (TTD) for doctorates. Many reports stress the importance of shortening the TTD, but provide no recommendations to achieve this goal. Herein, factors potentially affecting TTD are discussed and one mechanism that harmonizes undergraduate and graduate programs is proposed as a strategy to reduce the TTD.

Visual Analytics in Delirium Management.

BACKGROUND: Delirium is a patient safety issue that often occurs within the population of elderly people. As delirium may be characterized by fluctuating progress, the aim of this work is to find methods to visualize the occurrence of delirium over time in different patient stays in gerontopsychatric settings. METHODS: We analyzed current data mining visualization techniques for clinical research using a delirium data set collected in a gerontopsychatric setting. RESULTS: We identified heatmaps and dendrograms resulting from hierarchical clustering as a suitable visualization method. CONCLUSION: Heat maps with hierarchical clustering are a suitable data mining tool or visualization technique to study delirium cases in the time course of patient stays.

The costs and benefits of a modified biomedical science workforce.

Analyses of the biomedical research workforce, the biomedical research enterprise, and its sustainability have identified a number of threats and offered many solutions to alleviate the problems. While a number of these solutions have been implemented, one solution that has not been broadly adopted, despite being widely recommended, is to increase the number of staff scientists and reduce dependency on trainees. The perceived impediment of this is the cost. This paper explores the costs associated with laboratory personnel and the benefits, in terms of productivity, associated with different positions in the workforce. The results of this cost-benefit analysis depend upon the values assigned to different metrics of productivity by individuals and institutions. If first and senior author publications are the most important metrics of productivity, a trainee-dependent workforce is much more cost effective. If total publications are the most valued metric of productivity, the cost effectiveness of trainee and staff scientists is reasonably equitable. This analysis provides data for consideration when making personnel decisions and for the continued discussion of modification of the biomedical research workforce. It also provides insight into the incentives for modification of the workforce at the grass roots, which must be considered by institutions genuinely committed to workforce modification to sustain the biomedical research enterprise.

Functional Hierarchy and Cooperation of EMT Master Transcription Factors in Breast Cancer Metastasis.

Several master transcription factors (TF) can activate the epithelial-to-mesenchymal transition (EMT). However, their individual and combinatorial contributions to EMT in breast cancer are not defined. We show that overexpression of EMT-TFs individually in epithelial cells upregulated endogenous SNAI2, ZEB1/2, TCF4, and TWIST1/2 as a result of positive feedback mediated in part by suppression of their negative regulator miRNAs miR200s/203/205. We identified TCF4 as a potential new target of miR200s. Expression of ZEB1/2 strongly correlated with the mesenchymal phenotype in breast cancer cells, with the CD24-/CD44+ stemness profile, and with lower expression of core epithelial genes in human breast tumors. Knockdown of EMT-TFs identified the key role of ZEB1 and its functional cooperation with other EMT-TFs in the maintenance of the mesenchymal state. Inducible ZEB1+2 knockdown in xenograft models inhibited pulmonary metastasis, emphasizing their critical role in dissemination from primary site and in extravasation. However, ZEB1+2 depletion one-week after intravenous injection did not inhibit lung colonization, suggesting that ZEB1/2 and EMT are not essential for macrometastatic outgrowth. These results provide strong evidence that EMT is orchestrated by coordinated expression of several EMT-TFs and establish ZEB1 as a key master regulator of EMT and metastasis in breast cancer. IMPLICATIONS: The EMT program is orchestrated by coordinated expression of multiple EMT transcription factors, whereas ZEB1 integrates the EMT master regulatory network and plays the major role in promoting EMT and metastasis.

Evaluating Performance and Interpretability of Machine Learning Methods for Predicting Delirium in Gerontopsychiatric Patients.

Delirium is an acute mental disturbance that particularly occurs during hospital stay. Current clinical assessment instruments include the Delirium Observation Screening Scale (DOSS) or the Confusion Assessment Method (CAM). The aim of this work is to analyze the performance of machine learning approaches to detect delirium based on DOSS and CAM information obtained from two geropsychiatric wards in Tyrol. From a machine learning perspective, the questions of these two assessment instruments represent the features and the ICD 10 diagnoses of delirium (yes/no) is the corresponding class variable. We compare seven popular classification methods and analyze the performance and interpretability of the learning models. As our dataset is highly imbalanced, we also evaluate the effect of common sampling methods including down- and up-sampling methods as well as hybrid methods. Our results indicate a high predictive ability of advanced methods such as Random Forest that can handle even unbalanced datasets. Overall, combining a good performance of a prediction model with the ability of users to understand the prediction is challenging. However, for clinical application in fully electronic settings, a good performance seems to be more important than an easy interpretation of the prediction by the user. On the other hand, explanations of decisions are often needed to assess other criteria such as safety.

Implementing National Electronic Health Records in Nursing Homes in Tyrol: A Nursing Management Perspective.

BACKGROUND: Health information technologies as electronic health records (EHR) have the potential to improve the quality and efficiency of health care. Implementing national EHR in nursing homes in Tyrol is a required task within the next years. OBJECTIVES: To explore and analyze the current situation of information exchange in nursing homes in Tyrol as well as expected potentials and challenges of an ELGA implementation from a nursing management perspective. METHODS: Semi-structured interviews with nine nursing managers of nursing homes in Tyrol were conducted and analyzed using qualitative content analysis. RESULTS: The explorative interviews offered a glance at the actual information exchange with other institutions and at the perception of nursing managers regarding potentials (e.g. decreasing organizational effort) and challenges (e.g. incompleteness of available patient information) of the nationally mandated implementation of ELGA in the nursing homes in Tyrol. CONCLUSION: The interviews with the nine nursing managers of nursing homes in Tyrol revealed some hopes (e.g. the reduction of double documentation) that ELGA will probably not be able to fulfill.

Towards a Systematic Construction of a Minimum Data Set for Delirium to Support Secondary Use of Clinical Routine Data.

Patient safety is an important topic but non-trivial to measure, as it comprises very different phenomena. One important example of patient safety issues is delirium. Many approaches for the detection and prediction of delirium are described in the literature. However, additional effort is often needed for a comprehensive data collection and for the avoidance of potential biases. To systematize a process for the detection and prediction of delirium reusing available clinical routine data, we aim to develop a minimum data set (MDS) for delirium. By combining a top-down and bottom-up approach, we compiled a comprehensive delirium map containing potential delirium elements based on evidence. The alignment with clinical routine data led to a specific version of an MDS for delirium and revealed that most of the delirium elements could be identified within available nursing routine data.

Improving Patient Safety by Reusing Clinical Routine Data - An Expert Survey on Patient Safety Indicators.

BACKGROUND: Patient safety is an important issue and receiving increasing attention. Information technology (IT) and IT-based strategies as the secondary use of already existing data within hospital information systems can help to improve patient safety. OBJECTIVE: To investigate experts' knowledge and opinions regarding relevant patient safety problems, their measurability in existing clinical routine data and potential challenges in the field. We also wanted to get an overview of already deployed indicators for patient safety. METHODS: Semi structured interviews with 20 experts from different healthcare domains were conducted and analyzed using a qualitative content analysis methodology. RESULTS: The expert interviews offered a deeper insight into patient safety and quarried relevant patient safety problems including possibilities to measure them. The most often mentioned indicators were infection, complication and pressure ulcer. CONCLUSION: From an experts' perspective there are several challenges but equally a high potential for improving patient safety by the use of health IT.

What's in a name?

Numerous concerns have been raised about the sustainability of the biomedical research enterprise in the United States. Improving the postdoctoral training experience is seen as a priority in addressing these concerns, but even identifying who the postdocs are is made difficult by the multitude of different job titles they can carry. Here, we summarize the detrimental effects that current employment structures have on training, compensation and benefits for postdocs, and argue that academic research institutions should standardize the categorization and treatment of postdocs. We also present brief case studies of two institutions that have addressed these challenges and can provide models for other institutions attempting to enhance their postdoctoral workforces and improve the sustainability of the biomedical research enterprise.

Phospholipid binding to the FAK catalytic domain impacts function.

Focal adhesion kinase is an essential nonreceptor tyrosine kinase that plays an important role in development, in homeostasis and in the progression of human disease. Multiple stimuli activate FAK, which requires a change in structure from an autoinhibited to activated conformation. In the autoinhibited conformation the FERM domain associates with the catalytic domain of FAK and PI(4,5)P2 binding to the FERM domain plays a role in the release of autoinhibition, activating the enzyme. An in silico model of FAK/PI(4,5)P2 interaction suggests that residues on the catalytic domain interact with PI(4,5)P2, in addition to the known FERM domain PI(4,5)P2 binding site. This study was undertaken to test the significance of this in silico observation. Mutations designed to disrupt the putative PI(4,5)P2 binding site were engineered into FAK. These mutants exhibited defects in phosphorylation and failed to completely rescue the phenotype associated with fak -/- phenotype fibroblasts demonstrating the importance of these residues in FAK function. The catalytic domain of FAK exhibited PI(4,5)P2 binding in vitro and binding activity was lost upon mutation of putative PI(4,5)P2 binding site basic residues. However, binding was not selective for PI(4,5)P2, and the catalytic domain bound to several phosphatidylinositol phosphorylation variants. The mutant exhibiting the most severe biological defect was defective for phosphatidylinositol phosphate binding, supporting the model that catalytic domain phospholipid binding is important for biochemical and biological function.

The wind god promotes lung cancer.

In this issue of Cancer Cell, Li and colleagues demonstrate that the hematopoietic transcription factor Aiolos (named after the Wind God of Greek mythology) confers anoikis resistance in lung tumor cells through repression of cell adhesion-related genes including the mechanosensor p66Shc.