Unterrichtliche Konzepte individueller Lernförderung. Theoretische Impulse für die individualisierte und bildungsstandardbezogene Lernförderung auf Mikro-Ebene: ein Lehr-Lern-Modell zur Ko-Konstruktion im Unterricht

Im vorliegenden Beitrag wird versucht, den [Lehr-Lern-Prozess] in Hinblick auf individualisierten Unterricht genauer zu klären und auf die aktuelle Diskussion zur wirksamen Implementierung von Bildungsstandards zu beziehen. Dabei wird ein lehr-lerntheoretisches Modell dargestellt, das Orientierungshilfen für die lern-wirksame Gestaltung von unterrichtlichen Prozessen bieten soll. Es wird im Weiteren auf die folgenden Qualitätsmerkmale guten Unterrichts bezogen: das Fördern einer positiven Lernatmosphäre, das Herstellen einer (bildungsstandardbezogenen) Zielorientierung und die Berücksichtigung von Lernvoraussetzungen durch pädagogische Diagnostik, die mit aufgabenbasierten und protokollierten Lernförderungskreisläufen gekoppelt ist. Abschließend werden Anwendungsmöglichkeiten dieses Modells insbesondere in der Unterrichtsgestaltung und -evaluation kurz aufgezeigt und kritisch diskutiert.

Mikro- versus Makroperspektive der retributiven Gerechtigkeit, Strafziele und die Forderung nach Strafe

Wie Personen auf Straftaten reagieren und welche Strafziele sie dabei verfolgen, war bisher kaum Gegenstand psychologischer Forschung. In der vorliegenden Arbeit wird die dimensionale Struktur der Präferenz von Strafzielen untersucht. In zwei Befragungen wurden juristischen Laien Fallgeschichten zur Beurteilung vorgelegt (Raubüberfall, Körperverletzung, Betrug, Vergewaltigung). Die multivariaten Auswertungen weisen eine hohe Übereinstimmung auf: Strafziele lassen sich durch die zwei voneinander unabhängigen Dimensionen Strafhärte und Mikro- versus Makroperspektive klassifizieren. Wird eine Makroperspektive eingenommen, so ist dies mit einer stärkeren Gewichtung von Gesellschaftsinteressen verbunden sowie mit der Präferenz für das Strafziel der positiven Generalprävention. Die Mikroperspektive ist hingegen mit der Überzeugung verbunden, dass Gerechtigkeit insbesondere aus der Perspektive der konkret Beteiligten herzustellen ist. Je nach geforderter Strafhärte geht die Mikroperspektive mit einem Bias entweder für das Opfer und das Strafziel der Vergeltung oder aber für den Täter und das Strafziel der Resozialisierung einher.

Einflussfaktoren auf Soziale und Gesellschaftliche Lernprozesse im Wissenssystem Biolandbau

Eine Haupterkenntnis von Forschung über biologische Landwirtschaft im Kontext der Entwicklungszusammenarbeit ist, dass nachhaltigere Bewirtschaftung nicht nur von besseren Anbaumethoden, sondern viel mehr davon abhängt, wie diese Methoden verbessert und an spezifische ökologische und sozio-ökonomische Kontexte in einem kontinuierlichen Koproduktionsprozess von Wissen angepasst werden. Diese Untersuchung hat die Ergründung von Faktoren zum ziel, die die Wissenskoproduktion im Bioreisanbau ermöglichen oder hemmen. Anhand einer Multilevelanalyse wird darauf fokussiert, wie der sozio-ökonomische, kulturelle und ökologische Kontext konstituiert ist (Makro-Ebene) wie wichtige Interessegruppen zusammenarbeiten und soziale Lernprozesse fördern (Meso-Ebene) und zu welchem Grad diese Prozesse zur Verbesserung und Integration von biologischen Anbauweisen in die Lebensunterhaltungsstrategien der Bauern (Mikro-Ebene) beitragen. Erforschung von Fallbeispielen in Südkorea und Kambodscha zeigt, dass Schlüsselakteure wie "farmer promoters", "farmer researchers" und Gruppen deren Mitglieder diverse Motivation für eine kontinuierliche Partizipation in den Gruppen haben, entscheidende ermöglichende Faktoren darstellen. In beiden Fallstudien gibt es praxisnahe Ausbildungsgänge für Schlüsselpersonen, jedoch werden diese noch ungenügend in das Wissenssystem Biolandbau integriert und deren Positionen institutionalisiert.

Intraoperative Continuous Norepinephrine Infusion Combined with Restrictive Deferred Hydration Significantly Reduces the Need for Blood Transfusion in Patients Undergoing Open Radical Cystectomy: Results of a Prospective Randomised Trial

BACKGROUND Open radical cystectomy (ORC) is associated with substantial blood loss and a high incidence of perioperative blood transfusions. Strategies to reduce blood loss and blood transfusion are warranted. OBJECTIVE To determine whether continuous norepinephrine administration combined with intraoperative restrictive hydration with Ringer's maleate solution can reduce blood loss and the need for blood transfusion. DESIGN, SETTING, AND PARTICIPANTS This was a double-blind, randomised, parallel-group, single-centre trial including 166 consecutive patients undergoing ORC with urinary diversion (UD). Exclusion criteria were severe hepatic or renal dysfunction, congestive heart failure, and contraindications to epidural analgesia. INTERVENTION Patients were randomly allocated to continuous norepinephrine administration starting with 2 μg/kg per hour combined with 1 ml/kg per hour until the bladder was removed, then to 3 ml/kg per hour of Ringer's maleate solution (norepinephrine/low-volume group) or 6 ml/kg per hour of Ringer's maleate solution throughout surgery (control group). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Intraoperative blood loss and the percentage of patients requiring blood transfusions perioperatively were assessed. Data were analysed using nonparametric statistical models. RESULTS AND LIMITATIONS Total median blood loss was 800 ml (range: 300-1700) in the norepinephrine/low-volume group versus 1200 ml (range: 400-2800) in the control group (p<0.0001). In the norepinephrine/low-volume group, 27 of 83 patients (33%) required an average of 1.8 U (±0.8) of packed red blood cells (PRBCs). In the control group, 50 of 83 patients (60%) required an average of 2.9 U (±2.1) of PRBCs during hospitalisation (relative risk: 0.54; 95% confidence interval [CI], 0.38-0.77; p=0.0006). The absolute reduction in transfusion rate throughout hospitalisation was 28% (95% CI, 12-45). In this study, surgery was performed by three high-volume surgeons using a standardised technique, so whether these significant results are reproducible in other centres needs to be shown. CONCLUSIONS Continuous norepinephrine administration combined with restrictive hydration significantly reduces intraoperative blood loss, the rate of blood transfusions, and the number of PRBC units required per patient undergoing ORC with UD.

Best Practices in Robot-assisted Radical Cystectomy and Urinary Reconstruction: Recommendations of the Pasadena Consensus Panel

CONTEXT Robot-assisted surgery is increasingly used for radical cystectomy (RC) and urinary reconstruction. Sufficient data have accumulated to allow evidence-based consensus on key issues such as perioperative management, comparative effectiveness on surgical complications, and oncologic short- to midterm outcomes. OBJECTIVE A 2-d conference of experts on RC and urinary reconstruction was organized in Pasadena, California, and the City of Hope Cancer Center in Duarte, California, to systematically review existing peer-reviewed literature on robot-assisted RC (RARC), extended lymphadenectomy, and urinary reconstruction. No commercial support was obtained for the conference. EVIDENCE ACQUISITION A systematic review of the literature was performed in agreement with the PRISMA statement. EVIDENCE SYNTHESIS Systematic literature reviews and individual presentations were discussed, and consensus on all key issues was obtained. Most operative, intermediate-term oncologic, functional, and complication outcomes are similar between open RC (ORC) and RARC. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC generally requires longer operative time than ORC, particularly with intracorporeal reconstruction. Robotic assistance provides ergonomic value for surgeons. Surgeon experience and institutional volume strongly predict favorable outcomes for either open or robotic techniques. CONCLUSIONS RARC appears to be similar to ORC in terms of operative, pathologic, intermediate-term oncologic, complication, and most functional outcomes. RARC consistently results in less blood loss and a reduced need for transfusion during surgery. RARC can be more expensive than ORC, although high procedural volume may attenuate this difference. PATIENT SUMMARY Robot-assisted radical cystectomy (RARC) is an alternative to open surgery for patients with bladder cancer who require removal of their bladder and reconstruction of their urinary tract. RARC appears to be similar to open surgery for most important outcomes such as the rate of complications and intermediate-term cancer-specific survival. Although RARC has some ergonomic advantages for surgeons and may result in less blood loss during surgery, it is more time consuming and may be more expensive than open surgery.

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

CONTEXT Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed. OBJECTIVE To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC. EVIDENCE ACQUISITION Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted. EVIDENCE SYNTHESIS The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-25% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC. Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-29% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 67-76%, 68-83%, and 61-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. CONCLUSIONS Oncologic and functional data from RARC remain immature, and longer-term prospective studies are needed. Cumulative analyses demonstrated that lymph node yields and PSM rates were similar between RARC and ORC. Conclusive long-term survival outcomes for RARC were limited, although oncologic outcomes up to 5 yr were similar to those reported for ORC. PATIENT SUMMARY Although open radical cystectomy (RC) is still regarded as the standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RCs are becoming more popular. Templates of lymph node dissection, lymph node yields, and positive surgical margin rates are acceptable with robot-assisted RC. Although definitive comparisons with open RC with respect to oncologic or functional outcomes are lacking, early results appear comparable.