Growing old at home – Support through prophylactic home visits

Short title

  • Growing old at home / T5

Period

  • 02/2007 - 01/2010 

Leadership

  • Prof.Dr. Johann Behrens

Staff Members

Associate partners

  • Universität Leipzig, Klinik und Poliklinik für Psychiatrie
  • Universität Bremen, Zentrum für Sozialpolitik 

Support

  • Bundesministerium für Bildung und Forschung 

Abstract

Background

With regard to demographic changes in Germany, it can be assumed that the number of elderly and the resulting need for long-term care will increase in the near future. For many people, growing old in familiar surroundings is one of their strongest desires. Admission to a nursing home is often seen as an incisive event in life, apart from being a considerable financial burden for both the individual and the social service system. In our singularised society, long-term self-sufficiency and support from informal and professional carers at home are becoming more and more important.

Question

Can prophylactic home visits from qualified nursing staff help to determine the individual care and assistance required by those over 80, to strengthen their competences and resources for remaining autonomous, to optimise care provided by family members and to provide contact to ambulatory services if and when required.

Target

The purpose of this study is to determine whether prophylactic home visits for people aged 80 and over, combined with an improvement in care services and use of resources in the home, are effective in avoiding or delaying nursing home admission.

Methods

This study has been designed as a randomised controlled longitudinal (2 measurements: pre- and post-measurement after 18 months) intervention study, which is accompanied by a prospective social-epidemiological study of predictors for nursing home admission and a healthcare cost evaluation.

Sample

A total of 320 participants were recruited via general practitioners and hospitals in Leipzig and Halle. Inclusion criteria were: > 80 years old, care level I, care level applied for but refused (care level 0) or impairment in at least 3 ADL/IADL. The participants were randomly allocated to the intervention or control group.

Intervention

Both groups were subjected to a baseline assessment (socio-demographic, diagnoses, MMSE, quality of life, book of costs). At the same time as and subsequent to the baseline assessment, the intervention group underwent a comprehensive assessment regarding the current care situation (acc. to Geriatric Basic Assessment AGAST). After 2 – 3 weeks the results of the case studies, which had taken place in the meantime, were discussed with the test persons. One month later a third meeting took place, a so-called “booster session”, in which possible further implementation aid was given.

Expected results

We expect to find that proving the effectiveness and cost-effectiveness of prophylactic home visits can be a sensible and applicable intervention for elderly people living at home.

Additional publications

Fleischer S, Roling G, Beutner K, Hanns S, Behrens J, Luck T, Kuske B, Angermeyer MC, Riedel-Heller SG, Heinrich S, König HH, Lautenschläger C. Growing old at home - a randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]BMC Public Health. 2008 May 28;8:185. 

Development and evaluation of an assessment instrument for the oral care of ICU patients

Short title

  • AMI

Period

  • 2005 - 2008 

Leadership

Staff members

  • Simone Apling
  • Kerstin Celik
  • Anja Feicke
  • Birgit Feindt
  • Steffi Kern 

Associate partners

  • August Viktoria Hospital Berlin
  • Berufsgenossenschaftliche Kliniken Halle 
  • Hospital for Surgery Erxleben 
  • University Hospital Leipzig
  • University Hospital Magdeburg

Utilization of a checklist for physical rest as part of medically prescribed immobilization in pregnancy complications. A pilot study involving family care facilities in Bavaria

Short title

  • Checklist for physical rest in pregnancy complications

Period

  •  04/2010 - 04/2012

Leadership

Project implementation

  • Protestant family care service “Hesselberg” (Evangelischer Familienpflegedienst Hesselberg) with 12 facilities in Bavaria, Hesselbergstraße 26, 91726 Gerolfingen 
  • Family care unit of the Diakonie Lohr / Aschaffenburg / Schweinfurt, Rossmarkt 29, 63739 Aschaffenburg
  • Congregation of the Rita Sisters (Kongregation der Rita Schwestern), Family Care Section, Friedrich Spee Str. 32, 97072 Würzburg
  • Caritas Welfare Centre St. Gregor (Caritas Sozialstation St. Gregor), Fährbrück near Würzburg 
  • Diakonie „Aktiv“ GmbH, Schenkstr. 69, 91052 Erlangen

Abstract 

Purpose:

Women, who have been prescribed physical rest when treated for pregnancy complications as an outpatient, often describe fears, insecurity and conflicts. These can be intensified by the presence of existing children and because the social environment does not always understand the need for this treatment. In previous studies, women concerned expressed the need in this context for clear instructions concerning resting at home (Schmidt 2008, 2009).

Family nurses describe great fear and uncertainty in some women and risky behaviour in others; they would like to have a written guide on the degree of domestic rest as a support in their work with women and their families. 

In order to meet these wishes, a checklist for bed rest is to be tested in a pilot study (Maloni JA 1994, Schmidt 2008). The first test should be made with a small sample to find out whether the checklist can be adopted by treating physicians as a way to help women deal with bed rest in everyday life, and whether the checklist helps women to ask their doctor questions about bed rest and helps them deal with it in domestic life. In addition, the benefit of the checklist should be assessed by family nurses.

Methods:

Included in the study were women with pregnancy complications, whose treatment was to be supported by bed rest at home and include help by a housekeeper / family nurse . The evaluation of the checklist was carried out by rating scales supplemented by free text information.

First Results:

The results should be interpreted with caution due to the small sample. They show that the vast majority of participating physicians considers the checklist to be useful in certain situations. No contraindications were formulated and only a few doctors reject the use of a checklist, because they see no need for written recommendations in addition to the information they provide. It is interesting to see that the checklist is judged primarily by the interviewed family caregivers as helping them in their work with the women and their families. Some of the interviewed women described the checklist as a help when talking to the doctor and when implementing bed rest in everyday life, while other women saw no added benefit.

Conclusion and Forecast:

While it is not a problem for many women to conform with the instructions of the attending gynaecologist for bed rest in everyday life, other patients prefer written instructions and guidelines which seem to benefit them. A study should be made on a larger group as to which cases the use of the checklist for bed rest can be recommended and whether it is assessed as appropriate by supporting family members. It should also be checked with a larger group, whether the use of the checklist with affected women reduces their fears and uncertainty, helps to avoid conflicts or to improve adherence.

Literature:

  1. Maloni J A (1994) Home care of the high-risk pregnant woman requiring bed rest.
  2. J Obstet Gynecol Neonatal Nurs 25: 17-23
  3. H. B. Schmidt, H. Faller, M. Sütterlin Belastungen und Bewältigung bei Immobilisation wegen drohender Frühgeburt In: F. Siedentopf et al. (Hrsg.), Zwischen Tradition und Moderne Psychosomatische Frauenheilkunde im 21. Jahrhundert Beiträge der 37. Jahrestagung der Deutschen Gesellschaft für Frauenheilkunde und Geburtshilfe e.V. 2008, Mabuse Verlag, Frankfurt; 199-204
  4. H. B. Schmidt , H. Faller , M. Sütterlin Immobilisation bei drohender Frühgeburt – Belastungen und Bewältigung Eine qualitative Analyse von Gesprächen mit betroffenen Frauen und ihren Partnern Geburtsh Frauenheilk 2009; 69:1-5

Research project: violence and aggression towards professional nurses

Short title:

  • BauA

Period

  • September 2020 until March 2021

Project Lead:

  • Prof. Dr. Gabriele Meyer

Collaboration:

  • Dr. Steffen Fleischer
  • Dr. Jens Abraham
  • Uta Kirchner-Heklau

Funding:

  • Federal Institute for Occupational Safety and Health (BauA)

Management of the consortium:

  • University of Cologne, Faculty of Medicine, Institute of Nursing Science.

Further project partners:

  • Fulda University of Applied Sciences, Department of Nursing and Health

Project content:

Preparation of a scientific report on the topic of "Operational measures for dealing with challenging behavior, violence and aggression towards professional nurses in acute care hospitals: summary of the state of knowledge".

BraFaP: The Brandenburg skilled labour trial, section "care"

Short title

  • BraFaP

Period

  • 10/2011 - 06/2013

Leadership

  • Prof. Dr. Johann Behrens

Staff members

Partners

  • Centre for Social Research Halle (Sabine Böttcher, Susanne Winge)
  • Ruhr University Bochum (Prof. Rolf Heinze)
  • University Siegen (Prof. Christoph Strünck)
  • Evangelic University of Applied Sciences Freiburg (Prof. Thomas Klie)

Support

  • Brandenburgian Ministry of Labour, Social Affairs, Women and Families

Abstract

The study aims to formulate scientifically based recommendations for courses of action to ensure high quality care in Brandenburg. The study should provide answers on the following three study levels: 

(1) How can the development of care dependency be influenced (prevention and reduction of care dependency)? 

(2) What options are available in the regional health structures in Brandenburg, taking the local organisational strategies and possibilities into consideration?

Prevention of infection for liver-transplanted patients. Three Cochrane Reviews

Short title

  • Cochrane LTx

Period

  • 05/2007 - 07/2010

Leadership

Staff members

Associate partners

  • Cochrane Hepato-Biliary Group
  • Klinikum Regensburg

Support

  • BMBF

Abstract

Three Cochrane reviews were prepared on the following topics:

  1. Glucocorticosteroids for liver-transplanted patients
  2. Interventions for viral hepatitis B in liver-transplanted patients
  3. Nutritional interventions for liver-transplanted patients

Publications

  • Großmann K, Langer G, Saal S, Grothues D, Wienke A. Mycophenolate mofetil for liver-transplanted patients. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD007446. DOI: 10.1002/14651858.CD007446. 
  • Langer G, Saal S, Großmann K, Grothues D, Wienke A. Glucocorticosteroids for liver transplanted patients. Cochrane Database of Systematic Reviews 2009, Issue 1.
  • Langer G, Großmann K, Saal S, Grothues D, Wienke A. Nutritional interventions for liver-transplanted patients. Cochrane Database of Systematic Reviews 2009, Issue 1.

Presentation of social systems with the newly adapted family board for blind and visually handicapped people - a qualitative pilot study in vocational rehabilitation

Short title

Family board 

Leadership

Project implementation and staff

  • M. Schroeder and K. Kreißler, students of the master's programme in Health and Nursing Sciences
  • Facility: 2BFW Halle (Saale) gGmbH, A. Kunnig

Abstract 

Background

A new onset of severe visual impairment requires occupational and social reorientation, supported, for instance, by rehabilitation in vocational training centres. To enable affected persons to represent visually the changes experienced in social and family relationship structures and thus to facilitate such exchanges, the family board [1] has been adapted for the visually impaired [2] and was applied in this pilot study.

Methods and Sample

In this pilot study, seven participants described their subjective experiences of the social and family situation by using family board constellations as part of a vocational rehabilitation in the Vocational Training Centre Halle (Saale). The participants then judged the usability of the adapted family board.

Results

It was shown that this method also provides blind people with a visual representation of relationship constellations. Mental images that are difficult for some people to put into words can be communicated to sighted or other visually impaired persons. For the purposes of accessible treatment, the use of this method of communication is conceivable, among others, as support for coping strategies, for identification of rehabilitation goals, as well as their verification and adjustment in the course of rehabilitation.

Literature

  1. Ludewig 2000, Das Familienbrett, Hogrefe, Göttingen
  2. Schmidt H. & Abel, T. (2011), Neu aufgestellt - Das Familienbrett für Blinde und Sehbehinderte. Ein Beitrag zur Barrierefreiheit in Therapie und Beratung, Horus, Marburger Beiträge zur Integration Blinder und Sehbehinderter, Jahrgang 73, 4/2011

Development of evidence-based health information in cooperation with the Stiftung Gesundheitswissen

Time Period

  • June 2018 to January 2019

Project leader

Staff members

Funding

Summary

Background

There is a demand for evidence-based health information nationally as well as internationally. Different health information is developed as part of a cooperation with the Stiftung Gesundheitswissen. The first topics are (postpartum) depression and anxiety disorders.

Methods

The development of health information follows the methods of evidence-based medicine and good practice guidelines for health information. Furthermore, the recommendations of the guideline evidence-based health information are applied (Verlinkung: www.leitlinie-gesundheitsinformation.de/leitlinie/).

Needs assessment and evidence synthesis are conducted by the working group. Moreover, basic texts are written. The translation into plain language and the (graphical) design are accomplished by the Stiftung Gesundheitswissen.

Evidence-based Nursing South Tyrol

Short title

  • EbN South Tyrol

Period

  • 09/2006 - 04/2011

Leadership

Associate partners

  • South Tyrolean Health Service (Sanitätsbetrieb), Director of Nursing
  • Health Districts of Bolzano, Bressanone, Brunico, Merano
  • Province College Claudiana
  • Professional Association (Berufsverband) IPASVI

Support

  • Council for Health and Welfare (Assessorat für Gesundheits- und Sozialwesen), Agency for training for healthcare workers, Bolzano, Italy

Abstract

In 2006, the project "Evidence-based Nursing South Tyrol" was launched with the objective of establishing a group of EBN experts. The main tasks of this group are to create guidelines, to support the implementation, and to evaluate the implementation. The group is composed of representatives from the four health districts Bolzano, Brixen, Bruneck and Merano as well as from the Claudiana Provincial College and the professional association IPASVI.

In preparing the guidelines, the following approach was selected, based on high-quality guidelines, such as the WHO guidelines: The guideline group was deliberately composed of representatives from all health districts, the state college as well as the professional organization in order to facilitate implementation on a broad front. In line with the primary theme of "oral care", questions with high practical relevance were derived  and outcomes were identified by brainstorming. These outcomes were prioritized in the next step and were supplemented by outcomes from patient groups (Cochrane Consumer Network, Tyrolean Cancer Aid). When possible, systematic reviews were created to all questions concerning the respective outcomes, . For this purpose, the Medline, the Cochrane Library, and CINAHL guideline databases were researched. The quality of the evidence was assessed by using GRADE, which was also applied when deriving recommendations.

Unfortunately, only a few studies with sufficient quality were found. One of the strengths of the proposed approach is that the guideline was created by nurses, thus reducing the barriers towards implementation.

Effect of Person-Centred Care on antipsychotic drug use in nursing homes: a cluster randomised controlled trial

Short Title

  •  EPCentCare

Period

  • 03/2014 - 08/2017

Project Leader

  • Prof. Dr. phil. Gabriele Meyer (Halle)
  • Prof. Dr. phil. Sascha Köpke (Lübeck)
  • Prof. Dr. med. Andreas Sönnichsen (Witten)

Staff members

  • Dr. Almuth Berg
  • Dr. Steffen Fleischer
  • Christin Richter, M.Sc GPW
  • Dr. med. Ursula Wolf
  • Henriette Langner, B.A.

Associate Partners

  • Institute of Social Medicine and Epidemiology, University of Lübeck, Germany
  • Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Germany

Support

  • German Federal Ministry of Education and Research (BMBF grant: 01GY1335A)

Abstract  

Background

The majority of nursing home residents with dementia experience behavioural and psychological symptoms of dementia (BPSD) like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany and other European countries, antipsychotics are prescribed in up to 30% of nursing home residents. Antipsychotic drugs seem to be prescribed as first line treatment for BPSD. A huge number is prescribed for inappropriate reasons and for a too long period without carrying out regular review. All antipsychotics are associated with an increased risk of stroke. Adverse effects also include sedation, dizziness and increased risk of falling. A Cochrane review indicates that training and support for care home staff reduces antipsychotics in residents with dementia.

Aim

This study aims to investigate whether a recently in the United Kingdom successfully proven person-centred care approach in nursing home residents (Fossey et al., 2006) can be implemented in German nursing homes and results in a clinically relevant reduction of the number of residents taking antipsychotic drugs compared to a control group. 

Methods

The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial skill training on person-centred care and on-going training and support programme) with a control group receiving optimized usual care. Both study groups will receive a medication review by an experienced psychiatrist with feedback to the prescribing physician. Overall, 36 nursing homes from East, North and West Germany will be included and randomised in one of both groups. 
 The primary endpoint will be the proportion of residents receiving at least one antipsychotic prescription at 12 months. Secondary outcomes are residents’ quality of life, behavioural and psychological symptoms of dementia (BPSD) as well as safety parameters like falls and fall-related medical attention. Cost parameters will be collected and process evaluation will be performed.

Trial Registration

ClinicalTrials.gov Identifier: NCT02295462

Keywords

  • implementation research 
  • nursing homes
  • antipsychotic medication
  • dementia 

Family midwives in Saxony-Anhalt: Home-visiting by qualified midwives with additional qualifications

Short title

  • Family midwives in Saxony-Anhalt 

Period

  • 06/2006-12/2007

Leadership

Associate partners

  • Landeshebammenverband Sachsen-Anhalt e.V. 

Support

  • Landeshebammenverband Sachsen-Anhalt e.V. 

Abstract

Background

Since early 2006, the Ministry of Labour, Women, Health and Social Affairs of Saxony-Anhalt, in cooperation with the National Confederation of Midwives, has been carrying out the project "Family midwives in the state of Saxony-Anhalt", which includes a modularized, practice-reflecting training of 260 hours. By the end of 2007, 21 midwives had been trained for their expanded field of activity. Another course started in February 2008. The activities of the family midwives include - in addition to billable services up to the 8th week according to the Midwife Fee Regulations (HebGV; Association of German Midwives Association 2004) - the health and psycho-socially oriented care visits in the home environment of particularly stressed women / families up to the end of the child’s first year. The remuneration for services rendered is ensured by the Ministry of Labour, Women, Health and Social Affairs of Saxony-Anhalt up to a maximum of 10 hours per week per family midwife.

Questions

How effective are interventions by the family midwives in terms of general self-efficacy and parental competence or controlling conviction of the mothers? (Outcome orientation)
 How do clients appreciate the expanded activity by the family midwives? (Client orientation)
 What support services are provided by the family midwives with regard to the health and psychosocial needs of the women / children cared for? (Process orientation)
 With which care activities do the family midwives liaise and to which care activities do they refer the families they care for? (Process orientation)  

Methods

A multi-page pre-post design, standardized assessment instruments; prospective documentation of care services by the family midwives.

Results and Discussion

see pdf-paper of the publications

EarlyStart – Early prevention for infants and their families provided by qualified family midwives in Saxony-Anhalt

Short title

  • EarlyStart (FrühStart)

Period

  • 09/2007 - 10/2009

Leadership

Staff members

Associate partners

  • National Centre "Frühe Hilfen" of the BMFSFJ 
  • Ministry of Helath and Social Services Saxony-Anhalt 
  • Landeshebammenverband Sachsen-Anhalt e.V. 
  • Family midwifes of Saxony-Anhalt 
  • Department of Children, Youth and Families (Halle/Saale) 
  • Nationwide model projects of the National Centre "Frühe Hilfen"

Support

  • BZgA, Cologne

Abstract

Background

The aim of the project was to examine the effectiveness of family midwives, who have been qualified in Saxony-Anhalt since 2006, and also their integration into already existing care structures.  The evaluation not only assessed what the family midwives had achieved for women/families with health and psychosocial risk factors, but also the access, interfaces and transitions from and to other participants in the health and social sector in the region.  The assessment evaluated the quality of the care and support for the target group during the course of the pregnancy and up to the end of the child’s third year.

Method

The methodical approach included partly standardized assessment tools and documentation forms as well as interviews with experts. Aided by case vignettes (scenarios from practical examples), typical client paths were evaluated and developed. In addition, guideline-supported interviews and partly standardised telephone interviews were held with the clients in order to determine their subjective perspectives to the support network and to evaluate the sustainability of the support and the clients’ empowerment for self-help. Network communication and finding out about the access and transition barriers or gaps were major focus points of this project.   

Sample

  • Care documentation on over 700 women/families and their children
  • 10 clients selected on the basis of theory-guided aspects (partly standardised personal interviews)
  • 30 guideline-based interviews with experts on various case vignettes in three regional settings (case control comparison)
  • 40 partly standardised telephone interviews with clients

Parameters and targeted outcomes

Illustrating the influence of the family midwife on the situation of the family/child, as visible, for example, in:

  • Utilisation of services and general self-efficacy (self-assessment by the women)
  • Utilisation of prophylactic measures (scans, vaccinations)
  • Taking a child/children into care because of endangerment to the child’s welfare
  • Assessment of parental control and competencies of the mother
  • Acceptance and rating of the family midwife by the women in the course of the support provided
  • Illustrating the regional integration and networking by the family midwives and other members of the care system:
    • Case vignettes (scenarios) demonstrating the network
    • Regional and adaptable client paths to enable quick decision-making
    • Depiction of the care system structure in various regions (case control comparison)

Press release:

Familienhebammen werden positiv beurteilt 

Publications

  • Ayerle, G. M., Luderer, C.  Behrens, J. (2010) Modellprojekt FrühStart - Evaluation der Familienhebammen in Sachsen-Anhalt: Vernetzung, Sichtweise der Klientinnen und Verankerung im Netzwerk Früher Hilfen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 53, 1158-1165 ISSN: 1436-9990
  • Ayerle, G. M., Luderer, C. & Behrens, J. (2010). FrühStart: Mütterliche Kompetenzen und Selbstwirksamkeitserleben. In Renner, I., Sann, A. & Nationales Zentrum Frühe Hilfen (Hrsg.), Forschung und Praxisentwicklung Früher Hilfen: Modellprojekte begleitet vom Nationalen Zentrum Frühe Hilfen. Köln: BZgA.
  • Luderer, C., Ayerle, G. M. & Behrens, J. (2010). FrühStart: Exemplarische Klientinnenpfade und Bruchstellen im System Frühe Hilfen. In Renner, I., Sann, A. & Nationales Zentrum Frühe Hilfen (Hrsg.), Forschung und Praxisentwicklung Früher Hilfen: Modellprojekte begleitet vom Nationalen Zentrum Frühe Hilfen. Köln: BZgA.
  • Ayerle, G. M. (2009). Prädikat Familienhebamme. Hebammenforum, 7, 529-535
  • Ayerle, G. M., Nitschke, M., Behrens, J. & Luderer, C. (2009). "FrühStart" - Die Betreuung hoch belasteter Familien durch Familienhebammen in Sachsen-Anhalt. In Frühe Hilfen interdisziplinär gestalten: Zum Stand des Aufbaus Früher Hilfen in Deutschland. Dokumentation der Fachtagung in Kooperation mit dem Nationalen Zentrum Frühe Hilfen und der Deutschen Gesellschaft für Sozialpädiatrie und Jugendmedizin e. V. vom 19.-21. November in Berlin (pp. 185-193). Berlin: Deutsches Institut für Urbanistik.
  • Luderer, C., Ayerle, G. M., & Behrens, J. (2009). Frühe Hilfen für Kinder in Familien mit multiplen psychosozialen Belastungen: Aufsuchende Hilfe durch Familienhebammen und interdisziplinäre Vernetzung im regionalen Hilfesystem. In M. Schulte-Markwort (Hrsg.), Psychosomatik Kinder- und Jugendpsychiatrie als interdisziplinäres Fach. XXXI. Kongress der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (S. 275-276). Hamburg, 4.-7. März 2009. Abstracts. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft. 
  • Ayerle, G. M., Luderer, C. & Behrens, J. (2009). Die Begleitung von Familien mit besonderen Belastungen durch Familienhebammen: Das Spektrum gesundheitsfördernder Leistungen und die Perspektive der Nutzerinnen. Hallesche Beiträge zu den Gesundheits- und Pflegewissenschaften, 8(1), 6-25. URL: media/HalBeitr/ Halle-PfleGe-08-01.pdf 
  • Ayerle, G. M. & Sadowski, K. (2008). Continuous health promoting care for vulnerable families by qualified 'family midwives' in Saxony-Anhalt. International Confederation of Midwives 28th Triennial Congress. Abstracts (CD-ROM), Amsterdam: Elsevier. 
  • Sadowski, K. & Ayerle, G. M. (2008). Evaluation des Projekts "Familienhebammen im Land Sachsen-Anhalt: Aufsuchende Familienhilfe durch qualifizierte Hebammen mit erweitertem Tätigkeitsfeld [Bericht für den Landeshebammenverband e.V.] 
  • Behrens, J., Ayerle, G. M., Höhne, A., Luderer, C. & Sadowski, K. (2007). FrühStart: Professionell gesteuerte Frühwarnsysteme für Kinder und Familien in Sachsen-Anhalt. Empowerment-Kongress. Magdeburg (Poster). 

Lectures

  • FrühStart – Familienhebammen in Sachsen-Anhalt'. Fachtagung des BMFSFJ und DGStB "Wirksamer Kinderschutz – Herausforderung(en) für die Kommunen", Berlin 2009 
  • Continuous health promoting care for vulnerable families by qualified 'family midwives' in Saxony-Anhalt'. International Confederation of Midwives' 28th Triennial Congress, Glasgow 2008 
  • Gesundheitsförderung durch Familienhebammen im Land Sachsen-Anhalt', XI. Hebammenkongress, Leipzig 2007 
  • Familienhebammen im Land Sachsen-Anhalt: Aufsuchende Familienhilfe durch qualifizierte Hebammen mit erweitertem Tätigkeitsfeld’, 12. Bundesweiter Kongress Armut und Gesundheit"Prävention für Gesunde Lebenswelten – ‚Soziales Kapital’ als Investition in Gesundheit", Berlin 2006

Appraisal of educational programmes and qualifications for health professions: a European comparison

Short title

  • GesinE

Period

  • 12/2009 - 11/2012

Leadership

  • Prof. Dr. Johann Behrens 
  • Prof. Dr. Margarete Landenberger 

Staff members

  • Dr. Gertrud Ayerle (cross-sectional tasks in work package 1 of the study)
  • Katrin Beutner (therapeutic professions)
  • Kathleen Karge (medical-technical radiology assistants)
  • Dr. Yvonne Selinger (nursing professions & project coordinator)

Associate partners

  • University of Applied Sciences and Arts (HAWK), Faculty of Social Work and Health, Hildesheim, represented by Prof. Dr. Bernhard Borgetto and the employees MSc Physiother. Holm Thieme and MSc Physiother. Susanne Max
  • German Institute of Hospitals (Deutsches Krankenhausinstitut, DKI), Dusseldorf, represented by Dr. Karl Blum  
  • Project Advisory Board:
    • Gerd Dielmann - ver.di Federal Administration, Berlin
    • Prof. Dr. Heidi Höppner - University Association Health Professions (HVG), Kiel 
    • Dr. Karl Kälble - AHPGS Accreditation Agency gGmbH, Freiburg i. Br.
    • Karin Oster - BBJ Consult AG, Berlin 
    • Gertrud Stöcker - German Education Council for Nursing Professions (DPR) 
    • Marco Kachler and Stephanie Stumpe - German Association of Technical Assistants in Medicine (dcta)
  • Contact persons in the reference countries France, Great Britain, Netherlands and Austria 

Support

  • BMBF (Federal Ministry of Education and Research)

Abstract

Background and Purpose

Impulse for this research project are the current social and scientific developments, which require constant changes in the health system and introduce members of the health professions to new challenges in terms of their qualifications and skills. In this regard, a further development of the current qualification paths and profiles on the basis of  validated research is essential.
  In Germany, degrees in the healthcare professions are so far - unlike in most European states  - acquired in secondary education and not in universities. It would be a false conclusion to assume solely from the localization of these professions in higher education  that their graduates have increased skills and competencies. Therefore a systematically applied, EU-comparative research is needed, which examines the relationship between academic and skills as well as the marketability of skills acquired in different sectors of education. Until now, such research results in relation to the health professions are lacking.
  Therefore, the GesinE-study will contribute to a basic survey and a systematic comparison of training in the healthcare professions, as well as their areas of activity, qualifications and competency profiles in Europe.

Methods

The study is carried out in three steps / work packages.

  1. For Germany, France, Britain, the Netherlands and Austria, the training of the 16 legally regulated health professions in Germany (with the exception of the Veterinary Assistant) will be described and compared with the help of an  analysis matrix, which has to be developed.
  2. This is then followed by the qualification analysis for health professions and nursing, radiological technology (MTRA) and physiotherapy.
  3. For the classification of these findings, they are put in relation to the relevant health systems and their corresponding training systems  in the  countries mentioned.

To realise the research goals, various qualitative and quantitative methods are used in the three work packages. Extensive literature searches and evaluations, analyses of job advertisements, interviews with job migrants , expert interviews, observation and focus group interviews in exemplary fields of action, as well as an online survey with nurses, medical-technical radiology assistants  and physiotherapists  are compared in the five countries.

The findings of the three work packages are subjected to a comparative analysis.

Expected Results

The project, which should be understood as a preformative evaluation study, is a contributing factor to  a basically neutral inventory and a systematic comparison of training in the healthcare professions as well as the comparison of the areas of activity, qualifications and competency profiles in Europe, particularly in the countries of Germany, France, Great Britain, Netherlands and Austria . The results of the study can serve as a basis for further objective discussion on the development and reorganization of education in the healthcare professions and to adapt the qualification processes in Europe.

Nursing homes in the COVID-19 pandemic

Short title

  • HEICO

Period

  • June 2020 to September 2020

Project leaders in Halle

Partners

  • Lübeck University
  • Fulda University
  • Cologne University
  • Bergische University Wuppertal
  • Carl von Ossietzky University Oldenburg
  • Bielefeld University
  • University Witten-Herdecke
  • Otto von Guericke University Magdeburg
  • Technical University Rosenheim

Funding

  • Own resources

Abstract

The nursing home facilities had to get used to adhering to the legal requirements for the prevention of COVID-19 and for dealing with infections, and at the same time they had to guarantee the nursing care for the residents. Some of the existing test guidelines and documentation requirements were suspended and the psychosocial situation of the residents was influenced by the ban on contacts.

The challenges and changes brought on by COVID-19 in residential long-term care facilities are the subject of the investigation.

In the consortium, responsibility for the coordination of all the project partners and working packages will be taken on by the university in Halle. The study center there is also involved in recruiting the facilities as well as in conducting and analyzing the interviews.  

Research issues of the project:

  1. Which challenges, measures and consequences have arisen in the organization of residential care facilities for the elderly because of the COVID-19 pandemic?  
  2. Which challenges, measures and consequences have arisen in the direct care provided in residential care facilities for the elderly because of the COVID-19 pandemic?
  3. Which challenges, measures and consequences have arisen for the residents and their relatives as a result of the COVID-19 pandemic from the perspective of the representatives of the residents and relatives?

Methodology

The study will be conducted as a qualitative cross-sectional study in a convenience sample (n=4-5 care facilities per study center). Guideline-based telephone interviews will be carried out with the facility managers and nursing supervisors as well as with the residential sector managers and senior nurses, who will be asked about their experiences in their facility from the start of the measures until the contact ban was eased (supervised by the University Cologne and the Martin Luther University, Halle-Wittenberg). In addition, interviews will be held with relatives and resident representatives in the facilities, who can provide information about the restrictions experienced and the strategies for dealing with the pandemic situation (supervised by the University Witten-Herdecke and the University Bielefeld).

The interviews will be recorded digitally, transcribed and evaluated according to Ritchie and Spencer’s Thematic Framework Analysis. All the interviews will also be analyzed in terms of the incidence of and coping with violence caused by the restrictions of the Covid19 pandemic (supervised by the University Fulda).

Inter-professional documentation of information given to patients in hospital

Short title

  • IDAK

Period

  • 09/2004 - 06/2006

Leadership

Staff members

  • Monika Risse
  • Katrin Klaus
  • Tamara Heinich
  • Kathrin Kempe
  • Susanne Nebe
  • Martin Luderer
  • Anett Kretschmar
  • Maria Bauseler 
  • etc. 

Associate partners

  • University Hospital Halle: Ingrid Horn, Waltraud Janssen, Prof.Dr. Schmoll, Dr. Bettina Wollschläger
  • University Hospital Leipzig: Christine Naß, Prof.Dr. Krüger, Prof.Dr. Wirtz

Support

  • Robert-Bosch-Stiftung
  • Wilhelm-Roux-Programm 

Abstract

Background

Informing patients about diagnosis, prognosis and required medical therapy is solely the responsibility of members of the medical profession and may only be delegated within the professional category of physicians (LAK Baden-Württemberg, 2006). Nurses are permitted to speak to the patients about their illness, the prognosis and therapy. They are also in charge of the holistic care of the patients, which includes such conversations as part of the nursing profile (KrPflG § 3 Paragraph 1, Großkopf, 2002). However, a nurse may not impart to a patient any more information than that provided by the physician, nor alter the meaning of such information (Wiesing, Braunwald, Faul, 2002). Here a problem is revealed: If the nurses do not possess details about the information already imparted to the patient, they (the nurses) become unsure of themselves, which impedes the communication with the patient. (Luderer & Behrens 2005).

Questions

Is the average time spent by staff with the patient increased by including a questionnaire about the information imparted to the patient in the interdisciplinary documentation?

Is the communicative competence of the staff thus associated with an improvement of patients’ satisfaction?

Methods

Design: Duo-centric intervention study

Setting/Participants: Two wards with comparable routines and structural organisations.
Inclusion: Patients with or suspected of having bronchial cancer, German speakers, conscious, informed consent.
Exclusion: The time required for the interview was not noted if admissions or discharges were taking place in the room at the same time.

Method: Randomised allocation of the rooms included in the study, blinding of staff, protocol of all staff presence in a constantly occupied room over 24 hours (6:00 to 6:00 hrs weekdays). Patients were interviewed by means of a questionnaire concerning their satisfaction with staff communication (26 items). Depression and anxiety were recorded using HADS-D and the quality of life with WHOLQuol.Bref. Statistic evaluation with Excel and SPSS 12.0.

Current results

Data on the contact time and frequency were collected on 76 24-hour-periods in the intervention group and on 69 in the control group (N=145). In addition, 21 patients were interviewed in the intervention group and 25 in the control group.

The aim of the project was to prove the effectiveness of the documentation but this was achieved only to a certain degree. Neither the average daily contact time nor the frequency in the intervention group was significantly higher than in the control group. Whereas nursing staff on the early shift were more frequently present in the rooms of the control group, the late shift was more often in the rooms of the intervention group. However, it can be clearly seen that the average length of time spent by nursing staff on talking with patients in the intervention group is higher. There are no differences noted between the groups with regard to contact by physicians.

Discussion

The IDAK questionnaire is a practical, useful instrument for nursing staff, when required, but has only little effect on the length of time spent by staff in the rooms or on the quality of life of the patients.

It is important that both physicians and nursing staff are made aware of the present legal situation: The physician has the responsibility of informing the patient (MBO-Ä, 2006), but both physicians and nursing staff are responsible for actually speaking with the patients, whereby the nursing staff is only allowed to mention what the physician has already told the patient (Wiesing, Braunwald, Faul, Garmer et al., 2000). In practice, this does not entail documentation of all conversations but means that the nursing staff must be informed about whether the patient has been informed of the diagnosis or whether the physician has the impression that the patient has actually realised the meaning of it. This means that physicians must be sensitized about their obligation to document everything for the nursing staff. In order to implement the IDAK questionnaire, the staff must have good communication competencies beforehand. To create these competencies by using the questionnaire is an unrealistic demand on that questionnaire.     

Additional publications:

  • Luderer, C.; Behrens, J.: Aufklärung im Krankenhaus. In: Pflege 18, 2005: 15-23. doi:10.1024/1012-5302.18.1.15

Implementation of a multicomponent intervention to prevent physical restraints in nursing home residents

Short Title

  • IMPRINT

Period

  • Jan. 2014 - Dec. 2016

Project Leader

  • Univ.-Prof. Dr. phil. Sascha Köpke
  • Univ.-Prof. Dr. phil. Gabriele Meyer

Staff members

  • Ralph Möhler, MScN, Dipl.-Pflegewirt (FH)
  • Jens Abraham, M.Sc GPW

Associate partners

  • University of Lübeck, Institute of Social Medicine, Section Nursing research (Coordinating Investigator)
  • School of Nursing Science, Faculty for Health, Witten/Herdecke University 
  • Health Sciences, MIN-Faculty, University of Hamburg 

Support

  • Federal Ministry of Education and Research (BMBF) (funding code: 01GY1336B)

Abstract  

Background

Physical restraints as bedrails and belts are still regularly applied in German nursing homes despite clear evidence showing their lack of effectiveness and safety. In a recent cluster randomised-controlled trial, the efficacy of a guideline-based multicomponent intervention has been shown with a significant reduction in physical restraint use without adverse events. 

Aim

This study aims to apply different versions of this intervention in nursing home residents in four different regions throughout Germany (the areas of Hamburg, Halle (Saale), Schleswig-Holstein and Witten) in order to assess the effectiveness of the programme in a large unselected group of nursing homes. 

Methods

The study is a cluster-randomised controlled trial comparing two intervention groups (1. updated original programme and 2. brief version of the programme) with a control group receiving optimized usual care. Overall, 120 nursing homes will be included, randomised to the three groups and followed up for 12 months. Physical restraint use will be assessed by direct observation. The primary outcome will be the proportion of residents with at least one physical restraint. Secondary outcomes are residents` quality of life as well as safety parameters like falls and fall-related fractures. Process and cost measures will also be assessed. 

Keywords

  • implementation research 
  • nursing home care
  • physical restraints
  • dementia 

Publications

Structured information given during the intensive care unit stay to improve communication. A randomized multi-centred study.

Short title

  • Information in ICU / T4 

Period

  • 04/2007 - 03/2010

Leadership

Staff members

  • Stephan Wendroth (Research Centre Halle)
  • Ralf Becker (Research Centre Marburg)

Associate partners

  • University Hospital Giessen and Marburg GmbH, Marburg
  • University Hospital of the Martin Luther University Halle-Wittenberg
  • Sana Heart Surgical Hospital Stuttgart GmbH

Support

  • BMBF (Federal Ministry of Education and Research)

Abstract

Background

Patients with hematological stem cell transplantation (HSCT) suffer from a range of symptoms including mucositis, fatigue and mobility/activity deficits. An evidence-based care program was developed and evaluated with the aim of improving the quality of life of these patients. 

Method

The study was designed as a consecutive, non-randomised study with control and intervention groups of patients at the University Clinic in Halle. Patients aged > 14 years suffering from a haematologic-oncological disease and allogenic or autologous HSCT were included.

After HSCT had taken place, the intervention group received modified care consisting of three modules based on self-management and focusing on mobility/activity enhancement, prevention of oral mucositis and nutritional support. Control group patients received standard care. Primary outcome was global health-related quality of life measured by EORTC QLQ C30 at discharge. To analyse the effect of the intervention a linear regression model was drawn on, whereby a priori determined disturbance variables were  taken as adjustment variables in the final model. Results

A total of 79 patients aged 53 ± 13 years participated in the study. With the exception of the ECOG function status, both groups had comparable baseline variables. The IG patients had  significantly worse functionality (p<0.01) at the start of the study.

No significant effect (p=0.1) of the intervention could be shown at discharge for the primary outcome of global health-related quality of life.

However, the patients in the intervention group used the available sport activities more intensively and were more satisfied with the counselling provided on promoting activity. They also profited from the secondary outcomes of dyspnoea symptom scales (p=0.01) and nausea/vomiting symptom scales (p=0.01). Furthermore, on average they were able to be discharged earlier than the patients of the control group. Content analysis of the sport therapists’ records underlines the special psychological situation of the patients, 45% of whom expressed anxiety, worry and grief.

Conclusion

The intervention could show no effect on the primary outcome; however, the results of the module Activity Promotion should be evaluated in randomised studies. The results also underline the necessity of interdisciplinary cooperation and improved communication between patients and all the members of the therapeutic team.

 [Trial Registration: Clincal trials NCT00804817; Deutsche Krebshilfe (DKH), Case number: 107498]

Additional publications

Fleischer S, Berg A, Neubert TR, Koller M, Behrens J, Becker R, Horbach A, Radke J, Rothmund M, Kuss O. Structured information during the ICU stay to reduce anxiety: study protocol of a multicenter randomized controlled trial. Trials. 2009 Sep 14;10:84. [NCT00764933]

Evaluation of the intensified rehabilitation aftercare programme

Short title

  • IRENA Evaluation

Period

  • 12/2008 - 11/2011

Leadership

  • Prof. Dr. Johann Behrens
  • Prof. Dr. Wilfried Mau

Staff Members

Institute of Health and Nursing Sciences

Institute of Rehabilitation Medicine

Associate partners

  • German Federal Pension Insurance
  • Research Association of Rehabilitation Sciences of Saxony-Anhalt and Thuringia

Support

  • German Federal Pension Insurance

Abstract

Background

By stabilizing and / or expanding successful therapy during medical rehabilitation and by continuing health-promoting lifestyles, rehab aftercare can make a significant contribution. The intensified rehabilitation aftercare program (IRENA) from the DRV Bund (German Federal Pension Insurance)  represents an important specific aftercare concept, within which complex rehabilitation care services have been provided since 2001as standard procedure for the five therapeutic areas of orthopaedics, cardiology, psychiatric disorders, neurological and metabolic disorders. While the use of this program increases annually by a double-digit growth in the number of participants, neither the initiation processes and recommendation of the IRENA program at the end of the medical rehabilitation nor its implementation aspects have yet been evaluated.

Purpose

The purpose of the study is to gain insight into utilization, assessment of the process, acceptance and processes of the aftercare program "Intensive rehabilitation care (IRENA)" and also about the one-year period following the end of the treatment. From this it is hoped to obtain stimuli and suggestions towards optimising the process both internally and externally.    An explicit focus is on the identification of reasons for low utilization especially after cardiac rehabilitation.

Methods

The data collection during the study can be divided into three areas:

  1. Analysis of process data of IRENA's basic data and related data of the previous rehabilitation of the German Federal Pension Insurance 
  2. Survey of representatives of orthopaedic and cardiac rehabilitation facilities, partly by doing a full written survey on relevant aspects and partly by obtaining other findings from personal interviews drawn from a sample in both areas of therapy. 
  3. A written survey completed by IRENA participants in orthopaedic and cardiology facilities carried out in two phases (after completion of IRENA and one year later). In addition, the relevant IRENA result documentation and process data from the German Pension Fund will also be used for analysis.

Expected Results

Comprehensive findings on referral and provision of the aftercare program IRENA are expected. At the same time, the project provides a wealth of information on the evaluation of the program from the perspectives of the facilities and the patients. These are supplemented by findings concerning the health situation of the participants.
This leads to the possibility of evaluating the program and its design as well as showing starting points for further development.

JointConEval - Effectiveness of a complex intervention to improve quality of life and social participation in nursing home residents with joint contractures

Short title:

  • JointConEval

Duration

  • September 2017 until August 2020

Principal investigators

  • Prof. Dr. Gabriele Meyer
  • Prof. Dr. Martin Müller (Rosenheim, project coordinator)
  • Prof. Dr. Ulrich Mansmann (Munich)

Scientific staff

  • Katrin Beutner
  • Natalie Nguyen

Partners

  • Rosenheim Technical University of Applied Sciences, Faculty of Applied Health and Social Sciences
  • Ludwig-Maximilians-University Munich, Medical Faculty, Institute for Medical Information Processing, Biometry, and Epidemiology

Funding

  • German Federal Ministry of Education and Research (01GL1706B)

Study registration:

  • German Clinical Trial Register (DRKS), DRKS-ID: DRKS00015185

More details can be found here: https://bewegung-verbindet.de/english-version/

Background and Aims

Joint contractures are a common problem in frail elderly people and especially in nursing home residents. Restrictions in joint mobility resulting from inactivity, deformity, injuries, or pain have a negative impact on the quality of life, functioning and autonomy of those affected.

The JointConEval project aims to evaluate the effectiveness and safety of an intervention to improve the functioning and quality of life of older people with joint contractures in nursing homes, with a focus on improving social participation. The project aims to provide an evidence-based foundation for improving the care of individuals with joint contractures in nursing homes. 

Study design and methods

The evaluation of the effectiveness of the intervention follows the UK Medical Research Council's framework for the evaluation of complex interventions. The intervention developed in a preliminary study will be revised based on the results of the process evaluation and, if necessary, new scientific evidence and evaluated in a cluster-randomised controlled trial in two regions of Germany (Halle/Saale and Rosenheim/Munich). The participation of the residents as a primary outcome is assessed with the PaArticular Scales, which was developed in preliminary studies for use with patients in geriatric care with joint contractures. The effectiveness evaluation will be accompanied by a process evaluation and a health economic evaluation.

Expected results

We expect the clinically relevant improvement of participation of nursing home residents with joint contractures due to the implemented intervention. The evaluated intervention will be presented in a manual and translated into a training curriculum.

The intervention to be evaluated has the potential to improve the quality of care measured by patient-relevant outcomes and to achieve gains in effectiveness in health care, especially in the care of older people.

Keywords

Joint contracture, nursing home, activities, and participation

Somato-psychosocial interdisciplinary care program to improve care for cancer patients with stem cell transplantation (HSCT) - first results of a prospective non-randomized intervention study

Short title

  • KMT Project

Period

  • 03/2007 - 02/2010

Leadership

  • Prof. Dr. Margarete Landenberger (scientific leader)
  • Ingrid Horn (clinical leader)

Staff members

Former members 

  • Petra Renz
  • Steffi Oertel
  • Cornelia Baum (Study Nurse)

Associate partners

  • Institute of Media, Communication and Sports Department. Sports Science
  • Institute of Medical Epidemiology, Biostatistics, and Computer Science, Martin Luther University Halle-Wittenberg
  • University Hospital of Graz (Austria)
  • Ben Gurion University Beer-Sheva (Israel)
  • St. Martin College, University of Lancaster (GB) 
  • Memorial Sloan-Kettering Cancer Center New York (USA)

Support 

  • Deutsche Krebshilfe, Case No.: 107498 

Project execution 

  • University Hospital Halle, Medical Faculty, Martin Luther University Halle-Wittenberg

Abstract

Objective

Patients with hematopoietic stem cell transplantation (HSCT) suffer from a range of symptoms including mucositis, fatigue and mobility/activity deficits. This single center prospective non randomized clinical study examined whether an evidence-based interdisciplinary caring program would improve global health status and reduce somatic symptoms in patients with HSCT. 

Method

Patients with HSCT, age > 14 years and written informed consent were eligible. The intervention group received modified care consisting of three modules based on counseling and exercise focusing mobility/activity enhancement, prevention of oral mucositis and nutritional support. Control group patients received standard care. Primary endpoint was global HRQoL measured by EORTC QLQ C30 at discharge. Secondary endpoints were symptoms measured by EORTC symptom-scales, physical activity (kcal per week) and use of resources e.g. duration of hospitalization.

Results

82 patients participated (control group n=42, intervention group n=37, average age of 52.6 ± 12.7 years, 69.9 % male). Baseline characteristics were balanced between both groups except ECOG-status which was significantly lower for patients of the intervention group (p<0.01). All a priori specified covariates were included in the final regression model. At discharge statistically significant improvement could neither be shown for global health-related quality of life nor physical functioning nor fatigue but specific symptoms like dyspnoea and nausea/emesis were reported being significantly less severe by patients of the intervention group and duration of hospitalization was significantly shorter. Regarding physical activation patients in the intervention group were more active during hospitalization and reported significantly higher satisfaction with counselling concerning means to enhance their activity. However this level of activity was not maintained after discharge. Content analysis of the sports therapists’ records showed that 48% of the patients expressed anxiety and sadness during training sessions while the main obstacle for activity was the physical condition with fever and weakness (48% of the patients).

Conclusion

Even though the expected statistically significant improvement of HRQoL could not be achieved by the intervention, some symptoms were reduced and increased activity during hospitalization was achieved. Cost beneficial effects might be achieved by shorter hospitalization periods.

[Trial Registration: Clincal trials NCT00804817; Deutsche Krebshilfe (DKH), Case number: 107498]

Publications

Download

Online survey of the Early Help Networks in the state of Saxony-Anhalt

Short title

Early Help Networks

Period

08/2013 - 12/2013

Leadership

Prof. Dr. Gabriele Meyer/  Prof. Dr. phil. habil. Johann Behrens 
Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, 
Martin-Luther-Universität Halle-Wittenberg
Magdeburger Str. 8
06112 Halle/Saale

Prof. Dr. med. Dieter Körholz 
Universitätsklinik und Poliklinik für Kinder- und Jugendmedizin
Universitätsklinikum Halle (Saale)
Ernst-Grube-Straße 40
06120 Halle/Saale            

Staff members

  • Elke Mattern MSc 
  • Dr. rer. medic. Steffen Fleischer 
  • Dr. rer. medic. Gertrud M. Ayerle 
  • OA Dr. med. Daniel Clauß

Contacts

  • elke.mattern(at)medizin.uni-halle.de
  • steffen.fleischer(at)medizin.uni-halle.de
  • daniel.clauss(at)uk-halle.de

Partners (enquired)

  • Berufsverband der Kinder- und Jugendärzte e. V (Sachsen-Anhalt)
  • Berufsverband der Frauenärzte e.V. (Sachsen-Anhalt)
  • Deutscher Hebammenverband e.V. 
  • Bund freiberuflicher Hebammen Deutschlands e.V.
  • Ärztekammer Sachsen-Anhalt
  • Kassenärztliche Vereinigung

Support

Ministerium für Arbeit und Soziales des Landes Sachsen-Anhalt
Zentrum „Frühe Hilfen für Familien“
Turmschanzenstraße 25
39114 Magdeburg

Ansprechpartnerin: Frau Ilona Oesterhaus
Tel.: 0391 567 4037; Fax: 0391 567 4035
E-Mail: Ilona.Oesterhaus(at)ms.sachsen-anhalt.de

Abstract

Background

Little is known – neither in the Federal Republic nor in Saxony-Anhalt – about the experiences and demands of registered paediatricians, gynaecologists, general practitioners or independent midwives with regard to cooperating in the field of Early Help, particularly in the local Child Protection Agencies, in the state of Saxony-Anhalt. Neither has much research been done on this subject.

Based on information provided by 13 network coordinators in Saxony-Anhalt, it has been observed that a quantitative change in the network participation of paediatricians from 23% (2012) to 85% (2013) has taken place. The network participation of gynaecologists rose from 0% to 15% during this time. Reports about the participation of general practitioners showed an increase from 15% to 31% and that of midwives from 23% to 54% during the same period (Oesterhaus & Christoph, 2013). These professions are increasingly being included in structural concepts, but the factors and framework conditions which could promote and enable this are unknown.

Purpose

Survey of the perceptions of registered paediatricians, gynaecologists, general practitioners and independent midwives towards being (potential) cooperation partners in the local or regional Early Help Networks.

Reasearch questions

  • What do registered paediatricians, gynaecologists, general practitioners and independent midwives in Saxony-Anhalt think about a multi-disciplinary and multi-professional cooperation in the local or regional Early Help Networks?
  • Seen from the point of view of paediatricians, gynaecologists, and independent midwives registered in Saxony-Anhalt, what structural requirements are necessary in order to contribute actively to the Early Help system?
  • How have the paediatricians, gynaecologists, general practitioners and independent midwives registered in Saxony-Anhalt cooperated with other professionals and Early Help protagonists in the past?
  • What practical forms of cooperation (in the local or regional Early Help Networks) have proved successful from the point of view of registered paediatricians, gynaecologists, general practitioners and independent midwives?
  • What suggestions do registered paediatricians, gynaecologists, general practitioners and independent midwives have for practical forms of cooperation that could relieve them particularly in their daily praxis work?

Method

A cross-sectional survey of the targeted groups in Saxony-Anhalt will be conducted during September and October 2013:

  • Registered paediatricians n = 194 (GBE_Bund, 2012)
  • Registered gynaecologists n = 323 (GBE-Bund, 2012)
  • General practitioners n = 1,680 (GBE-Bund, 2012)
  • Professional midwives n = approx. 320 (Landeshebammenverband Saxony-Anhalt)

Result

The Ministry for Labour and Social Affairs in Saxony-Anhalt will receive a report, comprising the structured results of the online survey and the main statements realised. Based on this report, recommendations will be set up for involving and integrating the registered paediatricians, gynaecologists, general practitioners and independent midwives in the local or regional networks.

Literature

  • Baur, N & Florian. M. J. (2009). Stichprobenprobleme bei Online-Umfragen. In N. Jackob, H. Schoen  & T. Zerback (Hrsg.), Sozialforschung im Internet Methodologie und Praxis der Online-Befragung. Wiesbaden: VS Verlag für Sozialwissenschaften.
  • Bosnjak, M. & Batinic, B. (2002). Understanding the Willingness to Participate in Online Surveys. The Case of E-mail Questionnaires. In B. Batinic, U.-D. Reips, & M. Bosnjak, (Hg.), Online Social Sciences. Seattle et al., S. 81-92.
  • Couper, Mick & Coutts, E. (2006). Online Befragung. Probleme und Chancen verschiedener Online-Erhebungen. In A. Diekmann (Hrsg.) (2006), Methoden der Sozialforschung. Wiesbaden, S. 217-243.
  • Dillman, D.A. (2000): Mail and Internet Surveys. The Tailored Design Method. New York: John Wiley & Sons.
  • Kassenärztliche Vereinigung Baden-Württemberg (KVBW) (2013). Frühe Hilfen – Vernetzung lokaler Ange-bote mit vertragsärztlichen Qualitätszirkeln. www.kvbawue.de/praxisalltag/qualitaetssicherung/fruehe_hilfen/ (Stand: 25.6.2013)
  • Luderer, C., Ayerle, G. M. & Behrens, J. (2010). FrühStart: Exemplarische Klientinnenpfade und Bruchstellen im System Frühe Hilfen. In Renner, I., Sann, A. & Nationales Zentrum Frühe Hilfen (Hrsg.), Forschung und Praxisentwicklung Früher Hilfen: Modellprojekte begleitet vom Nationalen Zentrum Frühe Hilfen (S. 222-240). Köln: BZgA.
  • Oesterhaus, I. &  Christoph, M. E. (2013). Regelhafter Ausbau Frühe Hilfen aus Sicht des Landes Sachsen-Anhalt. Landeskoordinierungsstelle im Zentrum „Frühe Hilfen für Familien“ im Ministerium für Arbeit und Soziales des Landes Sachsen-Anhalt (Vortrag anlässlich des 18. Kongresses Armut und Gesundheit "Brücken bauen zwischen Wissen und Handeln - Strategien der Gesundheitsförderung" am 6. und 7.3.2013 in Berlin). www.fruehehilfen.de/fileadmin/user_upload/fruehehilfen.de/downloads/Regelhafter_Ausbau_Sachsen-Anhalt.pdf (Stand: 24.7.2013)

Nursing Leadership Educational Program for Doctoral and Postdoctoral Nurses

Short title

  • NurseLead

Project period

  • September 2017 - August 2020

Project leader

Project implementation

Project partner

  • University of Iceland (coordinator), University Medical Center Utrecht, Escola Superior de Enfermagem de Lisboa, University of Turku, Vilnius University
  • Elevate - online platform

Funding

  • Erasmus Programm (Erasmus+ strategic partnership for higher education)

Summary

The objectives of the project are 

  •  to stimulate the future generation of leaders in nursing education and research who encourage and foster high performing, education research environments, supportive and collaborative research output;  
  •  to train and educate postdoctoral nurses who will be qualified for professorships and doctoral students and thereby to focus on high quality education and research, as shown by substantial achievement in education, research, international collaboration impacting patients, families and  communities within Europe. 

Project contents

  • The project will develop:
  • Two blended learning modules for postdoctoral nurses and doctoral students
  • Online community and website 
  • Competency profile for nursing leaders
  • Massive Open Online Course (MOOC)
  • Assessment using research conducted throughout the project resulting in publications
  • Business model and sustainability plan

Non-physician health care providers for the treatment and care of the chronically ill (focusing on Disease-Management-Program diagnoses) - creating a literature-based expertise

Short title

  • NÄP-DMP

Period

  • 01/2007 - 06/2007

Leadership

Staff members

Support

  • Federal Association of the AOK (Health insurance fund)

Optimization of Patient Transition from Acute Care to Rehabilitation OPTIREHA

Title

OPTIREHA

Duration

  • 11/2013-12/2015

Funding

  • Wilhelm-Roux-Program (Support Code: 27/11)

Administrative Coordination

  • Dr. rer. medic. Patrick Jahn (Dipl. PGW), Leiter Pflegeforschung und Entwicklung, Universitätsklinikum Halle

Scientific Coordination

Staff members

  • Dr. med. Heike Schmidt 
  • Dipl. PGW Katrin Beutner

Cooperating centers

  • University Hospital Halle Saale, Department of Radiation Oncology
  • University Hospital Halle Saale Department of Internal Medicine Hematology
  • University Hospital Halle Saale, Department of Gynecology 
  • University clinic Freiburg Department of Internal Medicine 1

Abstract

 

Background: Rehabilitation for cancer patients aims to achieve improvement of reintegration, participation and quality of life. To reach these objectives patient transition from primary care to rehabilitation should be based on comprehensive trans-sectoral flow of information regarding patients’ individual condition and needs.

Objective: The multi-centre pilot-study aims to develop and pilot-test a modular assessment tool based on standard nursing assessments and ICF criteria in order to optimize patient transition between acute care and rehabilitation. 

Method: Analysis of exemplary patient records and structured survey of health care professionals (HCP) with respect to care transition resulted in suggested optimization measures that were consented (Delphi-survey) and pilot-tested in 4 centers in order to obtain first results regarding feasibility and acceptance.

Results: Analysis of patient records (n=12), and HCP questionnaires (n=13) in 3 centres showed insufficient assessment, documentation and communication of functional impairments and partly insufficient patient information. Standardized patient-information and an assessment tool based on nurse routine documentation and ICF criteria were developed. This OPTIREHA-Assessment comprises documentation of psychosocial aspects including information about patient related barriers and resources, assessment of functional impairments, special nursing needs and “red flags” indicating critical medical conditions demanding direct communication with the rehabilitation clinic. The pilot-testing showed reasonable time frames for completing the OPTIREHA-Assessment: Max. 5 min. were needed for summarizing existing data; max. 10 min. were needed if the assessment was completed in more than one go. Rehabilitation experts valued the information summarized in the OPTIRTEHA-Assessment.

Conclusion: First results indicate feasibility and possible benefit of the OPTIREHA-Assessment.

Participative Rehabilitation in Stroke Patients (PaReSiS)

Short title

  • PaReSiS

Period

  • 04/2008- 03/2011

Leadership

Institute of Health and Nursing Sciences:

University Clinic of Neurology:

  • Prof. Dr. med. Stephan Zierz
  • Dr. med. Tobias Müller

Institute of Medical Epidemiology, Biostatistics and Computer Science:

  • Prof. Dr. med. Andreas Stang MPH
  • Dr. sc. Hum. Oliver Kuss

Staff members

Associate partners

  • Forschungsverbund Rehabilitationswissenschaften Sachsen-Anhalt
  • Deutsche Rentenversicherung Mitteldeutschland

Support

  • BMBF (German Federal Ministry of Education and Research) as part of the research program "Patient-oriented research, patient orientation and chronic diseases"

Abstract

Background

Previous research regarding the perspectives of both patients and those undergoing rehabilitation following a stroke has shown a very mixed picture, particularly in the phase following rehabilitation (i.e. after-care) and on returning to everyday life and work (see Zimmermann et al. 2006). Although in some cases consecutive therapy does not always take place in spite of persisting impairment, other rehabilitants receive continual therapeutic care and assistance provided at their work place, which can be utilised for their rehabilitation. Family members and their family doctor often support them. However, there are consistent reports on the difficulties encountered with all the health insurance authorities before the necessary measures are granted.

Question

The project deals with the question of whether and to what extent a successful rehabilitation process following a stroke can be controlled by integrated, patient-oriented care management during the ambulatory after-care period. The focus lies particularly on how the rehabilitation process is planned for the time after discharge from the acute care facility (stroke unit) and on the in-patient and outpatient rehabilitation treatment offered. 

Method

The survey is designed as a controlled experimental study. The intervention program is offered to a random group of stroke patients. To ensure the validity of the instruments used, including the intervention, a sample for a qualitative interview is selected from both the intervention group and the control group.

Sample

The sample is selected from among patients of the Neurological Clinic at the University Clinic Halle, comprising of men and women over 18 years old suffering from an acute stroke (first stroke, ischaemic or haemorrhagic) and with corresponding diagnoses of ICD-10 161 and 163. Further inclusion criteria are main residence in the federal states of Saxony-Anhalt, Saxony or Thüringen and the ability to speak German.

Patients with reinfarction, alcoholism, NIHSS>25, homelessness (unable to be reached) or who have died in the clinic were excluded. Participants of both the intervention group and the control group were included in the qualitative part of the study.

Intervention

During the course of the intervention various access paths are used for the after-care rehabilitation process management:

  1. Information letters for the patients
  2. Internet portal
  3. After-care via telephone and hotline
  4. Central information meetings for patients and relatives
  5. Individual counselling for patients and relatives
  6. Mobile rehabilitation management (home visiting)

Thus, patients and their relatives have a choice, not only of controlling the amount of professional support but also of choosing between the various information possibilities.

Expected results

It is expected that the participants in the intervention group will differentiate significantly from those in the control group with regard to the main outcome of physical functionality.

Reduction of chemotherapy-induced anorexia, nausea, and emesis through a structured nursing intervention: a cluster-randomized multicentre trial

Short title

  • Nursing intervention cancer patients - BMBF-P4: Cluster-RCT

Period

  • 02/2004 - 01/2007

Leadership

  • Prof. Dr. Margarete Landenberger
  • Anette Thoke-Colberg
  • Ingrid Horn

Staff members

  • Petra Renz
  • Patrick Jahn
  • Ene Kukk

Associate partners 

  • Institute of Medical Epidemiology, Biostatistics, and Computer Science, Martin Luther University Halle-Wittenberg
  • University Hospital of Graz (Austria)
  • Ben Gurion University Beer-Sheva (Israel)
  • St. Martin College, University of Lancaster (GB)
  • Memorial Sloan-Kettering Cancer Center New York (USA)

Project execution 

  • Hospital “rechts der Isar”, Technical University Munich,
  • University Hospital Halle-Wittenberg
  • Medical Faculty of the Martin-Luther-University Halle-Wittenberg

Support 

  • Bundesministerium für Bildung und Forschung (BMBF), Förderkennzeichen 01GT0301

Abstract

Background

Following cardiovascular diseases, haematologic-oncological illnesses are with around 30% in second place on the list of mortalities in Germany, According to surveys, anorexia, nausea and emesis (ANE) are severe and frequent side effects of chemotherapy with major impact on quality of life and functioning of cancer patients (Berger, 2001; Foubert, 2005; Ihbe-Heffinger, 2004). A further growing problem is the growing knowledge gap and the lack of communication. Therefore, this trial evaluates Self Care Improvement through Oncology Nursing - SCION program to reduce distressing ANE in cancer patients undergoing chemotherapy. 

Question

Is it possible to reduce ANE considerably in cancer patients receiving moderate to high emetogenic chemotherapy if a structured and evidence-based care intervention is used instead of standard nursing methods in clinics?

Methods

Design: Cluster-randomised controlled multicentred study in cancer wards and day clinics (randomised units).

Setting: 14 cancer wards and day clinics at two German university hospitals.

Participants: 208 patients receiving moderate to high emetogenic chemotherapy. 

Main outcome

Reduction of ANE induced by chemotherapy, assessed by Common Terminology Criteria for adverse events (CTCAE Version 3.0)

Intervention

Based on a special assessment for chemotherapy-induced ANE (Stukenkemper, 2006), patients received an intervention consisting of 4 modules: information brochures and advisory consultation (Book et al., 2007), involvement in the anti-emetica prophylaxis (Jahn, 2006), nutrition counselling (Renz, 2007) and relaxation. The intervention was structured according to the care procedure and conformed with the NANDA-NOC-NIC classification system.

Results

When compared with standard nursing in clinics, the structured intervention did not result in a considerable reduction of ANE in cancer patients with moderate to high emetogenic chemotherapy. The mean difference in the control group was 0.68 points (95%CI -0.72 to 2.07; p=”0.23”) higher on the CTCAE Scale. With regard to self-care activity for reducing ANE, the patients in the control group performed 2.76 actions less (95%CI -8.83 to 3.31; p=”0.23”). No differences were noted regarding the patients’ knowledge of the side effects of chemotherapy and effective self-care measures or their self-care competence. The health-related quality of life was significantly better (9.36 points) for the patients in the control group (95%CI 2.13 to 16.58; p=”0.01”).

Discussion 

Contrary to our expectations, the structured self-care intervention did not result in a significant reduction of the ANE intensity in the intervention group, caused by the low incidence of ANE in both the control group and the intervention group at the start of the study. The significantly reduced  quality of life in the intervention group requires further investigation. 

Publications

  • Berger, A. M., Clark-Snow, R.A. (2001). Nausea and vomiting. In V. T. DeVita, Hellman, S., Rosenberg, S.A. (Ed.), Cancer: Principles and practice of oncology (Vol. 6, pp. 2869-2880). Philadelphia: Lippincott Williams & Wilkins.
  • Book, K., Landenberger, M., Stukenkemper, J., Renz, P., Jahn, P., Horn, I., et al. (2007). Information und Beratung für Patienten mit chemotherapiebedingten Nebenwirkungen: Eine evidenzbasierte pflegerische Praxisleitlinie. PrInterNet [im Erscheinen], Im Peer-Review-Verfahren.
  • Foubert, J., Vaessen, G. (2005). Nausea: The neglected symptom? European Journal of Oncology Nursing(9), 21-32.
  • Ihbe-Heffinger, A., Ehlken, B., Bernard, R., Berger, K., Peschel, C., Eichler, H.G., Deuson, R., Thodtmann, J., Lordick, F. (2004). The impact of delayed chemotherapy-induced nausea and vomiting on patients, health resource utilization and costs in german cancer centers. Annals of Oncology, 15(3), 526-536.
  • Jahn, P., Landenberger, M., Renz. P., Horn, I., Thoke-Colberg, A., Stukenkemper, J., Höhne, J. (2006). Pflegerische Mitwirkung bei der Antiemetika-Medikation für Patienten mit chemotherapie-bedingten Beschwerden: Evidenzbasierung einer pflegerisch-interdisziplinären Praxisleitlinie. PrInterNet [im Erscheinen]
  • Renz, P., Landenberger, M., Knerr, A., Bernd, U., Horn, I., Thoke-Colberg, A., Stukenkemper, J. (2007). Ernährung/-sberatung für Patienten mit chemotherapie-bedingten Beschwerden: Vorarbeit für eine evidenz-basierte pflegerisch-interdisziplinäre Praxisleitlinie. PrInterNet (1), 5-13.
  • Stukenkemper, J., Pröbstl, A., Lasic, G., Feistl, M., Nothdurft, I., Landenberger, M., Horn, I., Thoke-Colberg, A. (2006). Wissenschaftlich gestützte Pflegebedarfserhebung mittels eines pflegerischen Assessmentinstruments und dessen Nutzung in der Onkologie [unveröffentlicht]. Retrieved 16.03.2007, from http://www.printernet.info/pf06/pdf/ Stukenkemper.pdf.

Improvement of pain-related self-management for oncology patients through a trans-institutional modular nursing intervention: a cluster randomized multicentre trial

Short title

  • Nursing intervention oncological patients with persistent pain - BMBF-T3: Cluster-RCT

Period

  • 02/2007 - 05/2011

Leadership

  • Prof. Dr. Margarete Landenberger
  • Ingrid Horn
  • Anette Thoke-Colberg

Staff members

  • Petra Renz
  • Dr. Patrick Jahn
  • Ene Kukk

Associate partners

  • Institute of Medical Epidemiology, Biostatistics, and Computer Science, Martin Luther University Halle-Wittenberg
  • University Hospital Graz (Österreich)
  • Ben Gurion University Beer-Sheva (Israel)
  • St. Martin College, University of Lancaster (GB)
  • Memorial Sloan-Kettering Cancer Center New York (USA) 

Project execution

  • Hospital “rechts der Isar”, Technical University Munich,
  • University Hospital Halle-Wittenberg, Medical Faculty of the Martin Luther University Halle-Wittenberg

Support

  • German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF)

Abstract

Background

The prevalence rate of tumour-related pain varies greatly between the type of pain (nociceptive, neuropathic), the causal tumour disease and the population observed. German studiesd show a prevalence rate of 30-92% for pain due to gastrointestinal, bronchial and breast carcinomas (Petzke, Radbruch, Zec h, Loick, & Grond, 1999). By 85% of the oncology patients this pain is caused by the tumour (compression or infiltration of tissue susceptible to pain), by 17% the pain was caused by the treatment (radiation or chemotherapy, operation) and by 7% of the patients the pain occurred either in connection with the tumour disease (obstipation, decubitus) or it came from diseases or treatment not connected with a tumour (e.g. migraine) (Grond, Zech, Diefenbach, Radbruch & Lehmann, 1996).

The persistent pain experienced by cancer patients is a many-sided problem and requires a multi-disciplinary approach and cooperation between various professions (medical, nursing, psychology, spiritual welfare).  Controlling the pain of cancer patients is an important objective because oncological diseases normally have long progressions and, even with good chances of recovery, poses a major burden that is increased by persistent pain. For this reason it is important to strengthen the patient’s everyday competence so that by using self-management he is able to break out of the vicious circle of anxiety – pain – anxiety – loss of everyday competence – increased anxiety – depression (O’Donnell, 2004; Owen, 1990; Theobald, 2004). It is intended to stabilize the patient’s communication competence, which he learned on the ward, by applying a structured interdisciplinary care intervention with a multi-facility approach.

Question

Is it possible to alleviate the persistent pain experienced by cancer patients in the hospitalised phase as well as in the after-care phase by means of a structured, evidence-based, interdisciplinary care intervention consisting of several modules?

Methods

Design: Cluster randomised controlled multicentred study on cancer wards and in day clinics (randomised units).

Setting: 16 cancer wards and day clinics at two German university hospitals.

Participants: 240 patients with diagnosed malignancy (ICD-10 Category C: malignant new growth), persistent pain (longer than 3 days) and with a pain intensity of at least 30/100 mm on the Numeric Rating Scale (NRS).

Main outcome: Reduction of the average pain intensity using the 11-stage NRS (0-100mm). Comparison of the control and intervention groups 7 days after discharge.

Intervention: Consisting of the following modules: information brochures and advisory consultation, nursing/interdisciplinary cooperation in the pharmacological and non-pharmacological pain management, discharge management/after-care. A preceding assessment by the nursing staff is required in order to evaluate the care required by the patient as well as his/her resources and to prepare discharge management. The intervention was structured according to the care procedure and conformed with the NANDA-NOC-NIC classification system.

Results

SCION-PAIN program resulted in a significant reduction of patient related barriers to pain management one week after discharge from hospital: mean difference on BQII was 0.49 pts (95%CI, -0.87 pts. to -0.12 pts; P=0.02). The opened attitude enabled reduced pain intensity, improved adherence and HRQoL. 

Conclusion

This trial reveals the positive impact of an educational intervention to improve patients’ self-management of cancer pain and reduce care transition related problems. 

ClinicalTrials NCT00779597

Publications

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The Multimorbid Geriatric Cancer Patient – Therapy and Quality of Life

A Multicenter Study to Develop, Modulate and Pilot-test a Patient-centered Interdisciplinary Care Concept for Geriatric Oncology Patients (PIVOG)

Funding

  • Wilhelm-Roux-Program (Support Code: 28/20)

Duration

  • 05/2014-10/2016

Coordination

  • Dr. med. Heike Schmidt Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
  • Prof. Dr. med. Dirk Vordermark Department of Radiation Oncology, University Hospital Halle Saale, Martin Luther University Halle-Wittenberg, Halle, Germany
  • Prof. Dr. med. Karin Jordan Department of Internal Medicine IV, Hematology, Oncology, University Hospital Halle Saale, Martin Luther University Halle-Wittenberg, Halle, Germany
  • Prof. Dr. med. Ursula Müller-Werdan Charité – University  Hospital Berlin and Protestant Geriatric Centre

Clinical Partner

  • Dr. med. Eckhard Fiedler Department of Dermatology, University Hospital Halle Saale, Martin Luther University Halle-Wittenberg, Halle, Germany

Staff 

  • Dr. Stephanie Boese, Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
  • Katharina Lampe, Department of Radiation Oncology, University Hospital Halle Saale, Martin Luther University Halle-Wittenberg, Halle, Germany

Study Nurses:

Evelyn Teuber, Franziska Flessner, Alexandra Biolik

Abstract

Objectives

For elderly cancer patients the maintenance of independence, functionality and health-related quality of life (HRQOL) is of great importance. Aiming to maintain HRQOL of geriatric cancer patients we developed an interdisciplinary care program based on comprehensive geriatric assessment (CGA) and patient-reported HRQOL comprising tailored supportive measures and telephone-based counseling during 6 month aftercare. 

Materials and Methods

The project comprised two stages

1. Development and modulation of the complex intervention

In order to develop the complex intervention records of oncologic cancer patients older than 70 years will be analysed. In addition, a secondary data analyses will be conducted to identify relevant factors influencing health related quality of life of elderly cancer patients. 

1.3. Modelling of process facilitation including supplementary documentation 

2. Pilot testing and Evaluation

Pilot testing of the intervention took place in three centers at the University Hospital Halle to examine feasibility, acceptance and potential benefit. Patients ≥70 years with confirmed diagnosis of cancer, at least one comorbidity and/or one functional impairment, receiving curative or palliative care were eligible. Primary endpoint was global HRQOL (EORTC QLQ C30). 

Results 

Mean age of the participants (n=100) was 76.3 years (SD 4.8), 47 % were female. On average they had 5 comorbidities (SD 2.8, min. 0, max. 15) and took 8 prescribed medications (SD 3.6, min. 0, max. 15). According to predefined treatment pathways, supportive care was triggered by summarized individual assessments that were presented to the treating physicians. Descriptive analyses showed that global HRQOL measured at the 6-month follow-up (n=57) had declined (≥10 points) for n=16 (28 %) and improved or remained unchanged for n=41 (72 %) patients, although some functional scales (e.g. mobility, role function) and some symptoms (e.g. fatigue, pain) had worsened. The nurse-led telephone-based aftercare was well accepted.

Conclusion

The results show feasibility and potential benefit of the combination of CGA and HRQOL to complement standard assessments. Patient-reported symptoms and functioning indicate the need for intensified supportive therapy during aftercare.

Scientific Advisory Board and Cooperating Experts

Members of the scientific advisory board: Martin Luther University Halle-Wittenberg: Prof. Dr. rer. nat. Andreas Simm, Interdisciplinary Centre for Aging Halle (IZAH), Prof. Dr. med. Andreas Klement, Institute for General Medicine; Prof. Dr. phil. Gabriele Meyer, Institute for Health and Nursing Science, Dr. rer. medic. Patric Jahn, nursing research, PD Dr. med. habil. Anke Steinmetz, Department of Orthopedics, Dr. med. Tobias Wustmann, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine;  Dr. med. Michael Meisel, Internal Medicine, Head of Geriatrics, Diakonissenkrankenhaus Dessau; RN Kerstin Paradies, German Cancer Society, Oncology Nursing; Dipl. Med. Inf. Anke Wittrich, Federal Association of Geriatrics, MSc. Sven Weise, Head of the Cancer Society of Saxony Anhalt (SAKG) and patient representatives. International Experts: Prof. Colin D. Johnson, Cancer Sciences, University of Southampton, UK, Sally Wheelwright, MA (Cantab), University of Southampton, Morten Aagaard Petersen, M.Sc. The Research Unit, Department of Palliative Medicine Bispebjerg Hospital, University of Copenhagen, Dr. med. Jörg Sigle, Software Anyquest for Windows/QL-Recorder.

A mixed methods systematic review of pre-discharge home assessments in adult patients to improve the transition of care from the inpatient care to home care

Short title

  • Pre-discharge home assessment

Period

  • 01.08.2018 – 28.02.2019

Head of project

Project members

Funding

  • Self-financed by the Institute for Health and Nursing Science

Background

The treatment of inpatients with chronic diseases aims to preserve or even improve the patient’s participation. During their stay at acute care hospitals or rehabilitation facilities, the inclusion of patients’ home situations in preparation for their discharge is often insufficient and unsystematic. This is a general problem regardless of the patient’s disease. However, specific information on the patient’s ability to function at home is fundamental for participation-oriented therapy goals.

Even during inpatient rehabilitation, a systematic home assessment (environmental assessments, pre-discharge home visits, weekend passes) could contribute to a more specific discharge preparation. 

Firstly, it would be possible to test the functional abilities of the patient within his or her own home environment. Training, guidance and recommendations during therapy could then be made more participation-oriented. Secondly, necessary equipment and home adaptations could be identified prior to the patient’s return home. 

In some countries, such home assessments are a regular part of planning hospital discharge for certain groups of patients and are often carried out by Occupational Therapists. 

So far, there is insufficient systematic evidence on the question of whether and under what conditions pre-discharge home assessments can be successful.

Aim

The mixed methods review seeks to develop an aggregated synthesis of qualitative and quantitative systematic reviews on pre-discharge home assessments in order to derive conclusions and recommendations useful for clinical practice.

Therefore, the study aims to answer the following two research questions:

What is the effectiveness of pre-discharge home visits for improving the transition from inpatient care to home care in adult patients?

What are the barriers and facilitators and adverse events associated with pre-discharge home assessments?

Methods

A comprehensive literature search including a systematic search in data banks, reference lists and registers, a search for grey literature as well as a forward citation search will be conducted. Included will be individual or cluster randomised studies (RCT) and controlled clinical studies (CCT), qualitative studies and such studies with both qualitative and quantitative parts. Studies published in languages other than German or English will be excluded. Studies will be included that have participants over the minimum age of 18 and are not restricted to a certain indication or disease. Studies with problems exclusively in the cognitive and/or mental health area will be excluded. Included will be studies with interventions aiming either at the improvement of mobility and/or activities of daily living and/or at identifying the need for equipment and home adaptations (either together with or without the patient). The quality of all included studies will be assessed through two independent researchers using the following evaluation tools:  the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1 for RCTs and CCTs as well as the Critical Appraisal Skills Programme (CASP) for qualitative studies, and for mixed methods studies the Mixed Methods Scores (MM) of the Mixed Methods Appraisal Tool (MMAT). In the case of conflicts, a consensus will be reached through a third researcher. Meta-analyses will be performed when possible. The results on the effectiveness of interventions will be linked to barriers and facilitators and presented concisely.

The study is registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code number CRD42018100636.

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Multiple Symptoms in Cancer Patients: a Cross-sectional Multicentred Study

Short title

  • ProKID

Period

  • 06/2010 - 05/2011

Leadership

  • Prof. Dr. Margarete Landenberger (scientific leader)

Staff members

Associate partners

  • MRI, TU Munich

Support

  • ProKid, Society for the Promotion of Cancer Information in Germany, Heidelberg

Project execution

  • University Hospital Halle, Faculty of Medicine, Martin Luther University Halle-Wittenberg
  • Department of Gynecology (GST, day hospital)
  • Department of Oral-Maxillofacial Surgery (OMF)
  • Department of Internal Medicine I (ward 6) (Gastroenterology)
  • Department of Internal Medicine III (ward 9) (Pulmonology)
  • Department of Internal Medicine IV (ward 10-12, day hospital)
  • Department of Urology (ward 1, 2 & 3, day hospital)

Abstract

Background

Oncology patients experience a variety of symptoms as a result of disease and/or treatment. They often report co-occurrence of symptoms and functional impairments. Since persistent symptoms not only impinge on quality of life but also limit the intensity of the treatment, supportive therapy is needed to introduce alleviating measures as early as possible. For this purpose, standardised documentation of symptoms and good communication between the patient and the staff concerned should be sought. For this study and in cooperation with the Department of Symptom Research, Prof. Cleeland, the German version of the M.D. Anderson Symptom Inventory (MDASI-G) was applied in order to record the symptom distress experienced by cancer patients.  

Methods

Five university hospitals took part in this study, which had a multicentred cross-sectional design. The participants were 697 patients between the ages of 18 and 80 with diagnosed solid tumours, who were undergoing therapy either as out-patients or in-patients and who had given their consent to being questioned about their symptoms. The main outcome was to assess the symptom distress (symptom burden: total score of symptom distress and functionality restrictions) by asking the participants to make the assessment according to the MDASI-G and relating to the last 24 hours (NRS 0-10). Secondary outcomes were the coherences between symptom burden and distress and global quality of life (EORTC QLQ C 30).

First results

An average of 6 (±3) symptoms (intensity ≥1) were named. With regard to the stress levels, the symptoms mentioned most frequently were fatigue (43% slight, 26% moderate, 9% severe), worry/sorrow (36% slight, 23% moderate, 10% severe), sadness (36% slight, 18% moderate, 9% severe) and sleeping disorders (37% slight, 20% moderate, 10% severe). Severe restriction in everyday activities were mentioned by 18% of the patients. Significant coherences between symptom burden (MW 46.6 ±30.6) and the global health-related quality of life (MW 49.4 ±22.7) (r=0.66; p<0.01) were observed and also between symptom burden and distress (distress thermometer: MW 5.13 ±2.7) (r=0.59; p<0.01). 

Conclusion

The new MDASI scale seems to be quite suitable for recording the symptom distress experienced by cancer patients. Further surveys, focusing on various therapeutic settings and groups of patients, are necessary in order to optimise the rapid trans-disciplinary communication of all current symptoms and thereby improve the appropriate therapy.

PRO-ONKO: Patient-reported outcomes in the treatment of oncological patients - A multicentred pilot study to select appropriate assessment instruments

Short title

  • PRO-ONKO

Period

  • 03/2013-02/2014

Support

  • Wilhelm-Roux-Programme (Support Code: 26/15)

Leadership

Staff members

Partners: 

  • Univesity Hospital, Martin Luther University Halle-Wittenberg
  • University Hospital, Otto von Guericke University Magdeburg
  • HELIOS Hospital Sangerhausen

Abstract

Background: Cancer patients frequently suffer from various symptoms often impairing functional status and quality of life. Assessment of these symptoms and restrictions, including patients’ perceptions and self-assessment (Patient Reported Outcomes, PRO) is necessary to enable timely interdisciplinary supportive care and optimized therapy. However, PRO assessment is still not part of clinical routine despite various existing questionnaires. To facilitate the implementation of PRO assessment in daily clinical practice it is important to provide a choice of valid and feasible questionnaires meeting the requirements of both health care professionals (HCP) and patients in different settings. 

Purpose: This project therefore aims to compile an item pool from available tools, meeting the requirements of health care professionals and patients, in order to facilitate the use of PRO assessment for clinical decision-making. 

Methods: Qualitative, multicentre cross-sectional study comprising two stages in cooperation with physicians (surgery, internal medicine, radiation therapy), oncological nursing staff, members of the psychosocial services (psycho-oncologists, welfare workers) and patients diagnosed with various types of cancer, either hospitalized or receiving outpatient treatment. 

The first stage comprised interdisciplinary focus groups to define the particular requirements of the participating clinics with respect to PRO and to recommend suitable questionnaires. In the second stage patients completed the recommended questionnaires. In one centre data collection was carried out via tablet PC. The resulting PRO were compared with routine documentation and judged by patients and HCP’s with respect to usefulness for clinical routine.

Results: Patients and HCP’s judged the chosen questionnaires as appropriate and data collection via tablet PC as useful and easy to handle. Future studies should examine how PRO can complement or substitute parts of routine documentation in order to achieve standardized assessment and documentation during the treatment process in different settings and examine possible benefits for patients.

Partners: 

Martin-Luther University Halle-Wittenberg: 

  • Co-Investigator: PD Dr. med. Karin Jordan, Senior Consultant, University Clinic for Internal Medicine IV (Haematology and Oncology), University Clinic Halle (Saale)
  • Co-Investigator: Prof. Dr. med. Hans-Joachim Schmoll, Director, University Clinic for Internal Medicine IV (Haematology and Oncology), University Clinic Halle (Saale)
  • Co-Investigator: Prof. Dr. med. Dirk Vordermark, Direktor, University Clinic and Policlinic for Radiotherapy, University Clinic Halle (Saale)
  • Co-Investigator: Dr. rer. medic. Patrick Jahn (Dipl. PGW), Head of Nursing Research and Development, University Clinic Halle (Saale)
  • Susann Krasemann (Dipl.-Pflegewirtin FH), Director of Nursing, University Clinic Halle (Saale)
  • SAKG, Cancer Society of Saxony-Anhalt
  • APO, nursing work group in the Oncology Dept. of SAKG

Otto-von-Guericke-University Magdeburg: 

  • Co-Investigator: Prof. Dr. med. Henning Flechtner, University Clinic for Psychiatry, Psychotherapy and Psychosomatic Medicine for Childhood and Adolescence, Otto-von-Guericke-University Magdeburg
  • Co-Investigator: Dipl. Psych. Michael Köhler, University Clinic for Haematology and Oncology, Otto-von-Guericke-University Magdeburg
  • Dagmar Halangk (Dipl. Krankenschwester), Director of Nursing, University Clinic, Otto-von-Guericke-University Magdeburg 

Sangerhausen:

  • Dr. med. Bernd Klinge, Head Physician for General and Visceral Surgery, HELIOS Clinic Sangerhausen 

Cooperation with foreign partners

  • Univ. Doz. Dr. Bernhard Holzner (A), ESD – Evaluation Software Development 

Elektronic Data Collection, Software Development:

  • Dr. med. Jörg-Michael Sigle, Bern 

Preferences and deficits in midwifery care in Germany from the perspective of users and midwives: a qualitative explorative study

Summary 

Background: 

Internationally, research is lacking which may have the capacity to guide and inform evidence-based care by midwives. In Germany, so far there is neither a research agenda nor any research that specifically addresses the priorities of users (women, life partnerships, families) regarding their health care by midwives. In order to explore health care problems, interventions, or outcomes that do not neglect the needs, interests and preferences of users, the participation of users has been called for not only in research projects, 
but already in the process of identifying research priorities and research questions [1]. 

Objectives: 

The aim of the research project is to identify the preferences regarding midwifery care by both users and midwives and to deduce dominant themes for maternity care and midwifery research. 

Methods: 

This qualitative explorative research project is designed with reference to the hermeneutic approach according to Gadamer [2], which aims at a deepened and broad understanding of other perspectives. First, this is realized by an open approach and a reflective dialogue with the participants and the data by the research team, and secondly by an iterative process in data collection and analysis. 
Within a time frame of 12 months, there will be 14 focus groups with users and midwives in order to investigate their subjectively perceived preferences, or deficits, in midwifery care. The participants will be selected in two different states by means of a contrasting sampling technique based on various person-related characteristics. In order to safeguard an 
understanding that is based in data, the researchers will in case of unclear text passages call the respective participant by phone. The rights of users and midwives as participants as well as those of gatekeepers will be safeguarded. 
In the analysis, indicative statements for important themes of midwifery care and their meaning for the users and midwives in their respective context will be identified. These may refer to certain points in time, aspects, conditions, influencing factors, interventions, and outcomes of midwifery care. 

Relevancy: 

This research project will provide a significant empirical basis for the future development of a research agenda relating to midwifery care in Germany. This will not only base future midwifery research on user preferences, but also advance evidence-based midwifery care in Germany. 

References 

  • Chalmers, I. & Glasziou, P. (2009). Avoidable waste in the production and reporting of research evidence. The Lancet, 374(9683), 86-89. doi: 10.1016/S0140-6736(09)60329-9. 
  • [2] Fleming, V., Gaidys, U. & Robb, Y. (2003). Hermeneutic research in nursing: developing a Gadamerian-based research method. Nursing Inquiry, 10(2), 113-120. 

Mentally ill people in the Social Code (Sozialgesetzbuch, SGB) II

Short title

  • Mentally ill people in SGB II

Period

  • 10/2010 - 03/2011

Leadership

  • Prof. Dr. Johann Behrens

Staff members

Institute of Health and Nursing Sciences

  • Katrin Parthier
  • Dr. Michael Schubert

Aktion Psychisch Kranke e. V. Bonn

  • Jörg Holke
  • Ulrich Krüger
  • Prof. Dr. Reinhardt Peukert

Associate partners

  • Aktion Psychisch Kranke e. V. Bonn
  • Department of Labour Market and Employment Research in Nuremberg (Institut für Arbeitsmarkt- und Berufsforschung Nürnberg, IAB)
  • Research Association Rehabilitation Sciences of Saxony-Anhalt and Thuringia (Forschungsverbund Rehabilitationswissenschaften Sachsen-Anhalt-Thüringen)

Support

  • Federal Ministry of Labour and Social Affairs / Federal Labour Agency

Abstract

Background

People with psychiatric disabilities often find it very difficult to participate in working life. The illness often limits the ability to meet the requirements of the labour market, reduces the opportunity  for pursuing a professional career and – especially problematic for young mentally impaired people - the chance of reaching an educational qualification. 

In addition, high professional requirements, work intensification and work pressure are often incompatible with the (psychosocial) resources of  mentally impaired persons. Therefore, this group is more exposed to a higher risk of exclusion in working life (negative selection). On the other hand, permanent unemployment promotes the (further) deterioration of psychological health. Consequently, mentally impaired persons often have great difficulty in pursuing a professional activity. Therefore, it can be assumed that this group is over-represented in the group of people receiving benefits according to the second Social Code Book (SGB II).

Subject and Purpose

It is still unclear how the situation of mentally impaired but employable benefit receipients according to SGB II presents itself, both quantitatively and qualitatively.  the Four complexes of questions arise:

  1. What relevance do mentally impaired people have quantitatively for the employment services  (especially basic security support)? 
  2. What problems do people in this group have (qualitative) and can labour market policies and strategies help to improve their participation in working life?
  3. How is the knowledge about (status quo) and the handling of mentally impaired persons shown by the SGB II service providers on the one hand and, on the other hand, how are the possibilities of promoting jobs in psychiatric/psychosocial institutions? Is there a way to optimize potential?
  4. How is the cooperation between the various institutions and services, where are interfaces and networking opportunities?

Methods

In addition to a literature and document analysis, a total of 40 personal interviews were conducted in five regions nationwide with relevant professional protagonists. Included in the survey were:

  • PES staff in the jurisdiction of SGB II (primary insurance carrier)
  • Medical and psychological specialist services of the Employment Agency
  • Social psychiatric services
  • Institutions / possibilities for psychiatric treatment (e.g. psychiatric hospitals, day clinics)
  • Residential services and recommendations for social rehabilitation (daily living support)
  • Institutions / possibilities in the labour and employment sector (e.g. companies with social integration)
  • Integration services

Expected Results

Within the framework of five local reports, the study is expected to provide new insights into the number of mentally impaired people, who are beneficiaries of the SGB II. Moreover,  integration problems and support  perspectives will be described from a professional standpoint. In addition, the study will gain insights into a regional network of professional services and facilities to identify appropriate networking opportunities and future areas of research.

Implementation of the Resident Assessment Instrument (RAI) as a quality development and control tool in inpatient long-term care

Short title

  • RAI Project / T1

Period

  • 02/2007 - 01/2010

Leadership

Staff members

  • Dr. Yvonne Selinger
  • Karina Targan

Associate partners

  • Prof. Dr. V. Garms-Homolová, representative of interrai for Germany
  • Q-Sys Working Group, St. Gallen
  • Project A1 des Nursing Research Network North: G. Roth / H. Rothgang: Improving the effectiveness and efficiency of outpatient care at home by the Resident Assessment Instrument (RAI-HomeCare 2.0)

Support

  • Federal Ministry of Education and Research as part of the research program "Applied Nursing Research" in Nursing Research Network Middle-South 

Abstract

Background

The Resident Assessment Instrument is mandatory in publicly funded nursing homes in the United States. Numerous studies in the U.S. and now also in Europe have demonstrated sustainably the improvement of the process as well as the outcome quality of long-term care through the introduction and implementation of the RAI. Its measurement validity and the interrater reliability of the modules are confirmed (Hawes 1997, Austin 2004). Brandenburger (2002: 99) notes that the RAI provides explicit conditions for improving the quality of care, which was detected by Haxes / Vladeck (2005: 6-45) after implementation of the RAI in American nursing homes, especially in the area of process and outcome quality. Bernabei / Panfilo / Panio (2005: 99-117) concretise the achievements of the introduction of RAI in Italian nursing institutions, demonstrated by an improved care planning process and improved documentation. In the context of case management the hospitalization rate such as the length of hospital stay was also reduced (ibid.).

Question 

The implementation study will answer the question of whether the implementation and use of the Resident Assessment Instrument (RAI) can improve the quality of care in nursing homes demonstrably.

Methods

A cluster-randomized  controlled study will examine whether the implementation of the RAI in nursing homes leads to an improvement of the quality of the care provided. The 14 nursing homes included in the study will be divided into an intervention group with 7 homes, in which the RAI will be implemented, and a control group with the other 7 homes, in which the RAI will not be used. A total of 980 residents (40% drop-out taken into account) are included in the study.

In-house training for all the nurses in the nursing homes, who are responsible for the organization of the care process for the residents, will prepare them for the implementation and use of the RAI. The two-day course will provide training in the utilization of the RAI - based on the RAI manual - and also training in the basics of the nursing process and nursing documentation.

The measurements for the evaluation will be made in the institutions where the RAI is implemented as well as in the homes of the control group, keeping to the prescribed RAI time assessment in 6 month stages over a period of 1.5 years. Following these 18 months, , the rescheduled training and the accompanied implementation of the RAI will take place in the control group as well. Furthermore, nursing documentation analysis and interviews with nurses / residents regarding their health-related quality of life will be conducted. The quality of the implementation of the intervention will be shown by means of plausibility checks.

Expected Results

It is expected that on the residents’ level the intervention will lead to an improvement of the residents’ outcomes and of the quality of care when compared to the control group. An increase of the health-related quality of life is expected on the level of the residents and nurses. In addition, an improvement in the quality of nursing documentation and process planning is assumed.

Publications

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Preoperative information for ICU patients to reduce anxiety during and after the ICU-stay

Short title

  • RCT Intensive Care Unit

Periodum

  • 02/2004 - 01/2007

Leadership

  • Dr. Thomas R. Neubert (University Hospital Gießen and Marburg GmbH, Marburg)
  • Prof.Dr. Michael Koller (University Hospital Gießen and Marburg GmbH, Marburg)

Staff members

Associate partners

  • Research Centre University Hospital Giessen and Marburg GmbH, Marburg

Support

  • Federal Ministry of Education and Research

Abstract

Background

According to current evidence and psychological theorizing, the provision of information seems to be a promising way to reduce the patients’ anxiety related to their scheduled ICU stay. An ICU-specific information program will be investigated in a randomized controlled clinical trial involving 120 patients undergoing elective open-heart surgery and 20 patients undergoing abdominal surgery. It is expected that the patients in the test group will experience less anxiety and ICU-related discomfort than patients in the control group.

Objective

According to current evidence and psychological theorizing, the provision of information seems to be a promising way to reduce patients’ anxiety . In the case of surgical patients, admission to the intensive care unit (ICU) is strongly associated with uncertainty, unpredictability and anxiety for the patient. Thus, ICU-specific information could have a high clinical impact. For this reason, this study will evaluate the efficacy of an ICU-specific information program for patients who undergo elective cardiac, abdominal or thoracic surgery and who are scheduled for ICU stay.

Methods

The trial is designed as a prospective randomized controlled trial including an intervention and a control group. The control group receives the standard preparation currently conducted by surgeons and anaesthetists. The intervention group receives additionally a standardized information program with specific procedural, sensory and coping information about the ICU. In addition, the moderating effect of certain personality characteristics (need for cognition, high trait anxiety) will be investigated to identify groups of patients who benefit most from the information program.

Expected Results

A clinically relevant difference in anxiety and unpleasant experiences related to the ICU is expected after discharge from the ICU. Power calculation (alpha = 0.05; beta = 0.20; delta = 8.50 score points) resulted in a required sample size of N = 120 cardiac surgical patients (n = 60 vs. n = 60). Furthermore, N = 20 abdominal or thoracic surgical patients will be recruited (n = 10 vs. n = 10).

Conclusion

The proposed study promises to strengthen evidence on the effects of a specific, concise information program and thus should contribute to evidence-based nursing (EBN).

ClinicalTrials.gov Identifier: NCT00151554 

Additional publications 

  • Berg A, Fleischer S, Koller M, Neubert TR. Preoperative information for ICU patients to reduce anxiety during and after the ICU-stay: protocol of a randomized controlled trial [NCT00151554]. BMC Nurs. 2006 Mar 8;5:4

Optimization of the Access to Rehabilitation and Interfaces of Outpatient Care

Short title

  • RezuS

Period

  • 09/2010 - 02/2012

Leadership

  • Prof. Dr. Johann Behrens
  • Prof. Dr. Wilfried Mau

Staff members

Institute of Health and Nursing Sciences

Institute of Rehabilitation Medicine

Institute of General Medicine

Associate partners

  • Research Association of Rehabilitation Sciences of Saxony-Anhalt and Thuringia (Forschungsverbund Rehabilitationswissenschaften Sachsen-Anhalt-Thüringen)

Support

  • German Pension Insurance Funds Central Germany

Abstract

Background

In the course of an increasingly aging workforce, the working world is faced with the major challenge of preventing or to delaying health-related career exits and early retirements. Essential tools here are medical rehabilitation services. Previous studies showed, however, that a variety of problem areas and barriers complicate the access from ambulatory care to medical rehabilitation , or are in conflict with it. This is relevant both at the general practice level and in the specialist care settings.

Subject and Purpose

Subject of the project is the development and improvement of the involvement of registered general practitioners and medical specialists in the process for identifying rehabilitation needs and rehabilitation access for the workforce, since their role as central players in outpatient care and as "gatekeepers" in the rehabilitative care services is crucial. For this, the optimization possibilities and perspectives are examined from the perspective of practicing primary care physicians, rheumatologists, and social medicine experts from the service provider German Pension Insurance Fund for Central Germany. The aim is to uncover the optimization potential of rehabilitation access, to draft perspectives for reducing the (perceived) barriers and thus to support a needs-based rehabilitative care with targeted resource allocation.

Methods

The study is conducted as a consecutive two-step qualitative analysis. Here, initially for issue exploration, information will be collected in interviews with four focus groups of physicians as mentioned above. Subsequently, 30 personal expert interviews with general practitioners and rheumatologists in Saxony, Saxony-Anhalt and Thuringia will be conducted. The empirical surveys and analyses are complemented by a systematic literature review.

Expected Results

The results of the study should identify perspectives of the improvement of involvement and motivation of general practitioners and specialist physicians in the process of rehabilitation access. Here, the ways to improve cooperation between the protagonists are crucial (e.g. optimization of information and communication structures), in consequence of which (even by problematizing an inadequate supply) adequate rehabilitative care with targeted resource allocation is available.

In the medium term, both an improvement of communication between doctors and service providers as well as an improvement of the rehabilitation access management in the sense of appropriate and timely rehabilitation initiation can be achieved. The overall objective of the whole process is to maintain the ability to work and to avoid early retirement due to health problems.

Cross-interface, work-related case management of aftercare following addiction therapy as key to integration through employment and relapse prevention

Short title

  • SaBiNE

Period

  • 09/2011-08/2014

Study registration

  • DRKS00003574

Leadership

Institute of Health and Nursing Sciences

AHG Hospital Römhild

  • Prof. Dr. med. habil. R. Schlößer (Leader)
  • Jaqueline Zlatosch (Staff)

medinet AG Alte Ölmühle Magdeburg

  • Dr. med. Lukas Forschner (Leader)
  • Kerstin Urban (Staff)

Diakonie Hospital Harz Elbingerode

  • Joachim Stopp (Leader)
  • Jörg Mühlbach (Staff)

Soteria Hospital Leipzig 

  • Prof. Dr. med. Th. Kallert (Leader)
  • Bettina Stupnink (Staff)

Associate partners

  • Research Network of Rehabilitation Sciences Saxony-Anhalt

Support

  • German Pension Insurance Fund Central Germany
  • Federal Labour Agency 

Abstract

Background

Employment can improve stabile abstinence considerably (see Bieker 2005). Research on relapses in treating addiction shows that re-employment can reduce the relapse risk noticeably, both for drug and alcohol addicts (see Henkel 2008). However, a great many addicted persons remain unemployed, sometimes for years, because addictive disorders have negative effects on the opportunities for employment participation, resulting in long-term unemployment that has an obvious connection with establishing addictive behaviour (see Rose/Jacobi 2004).

Questions

The project examines the question of whether and to what extent a systematic, cross-interface and work-related case management (as a supplement to standard care) has a positive effect on the reintegration of rehabilitated addictive persons in the labour market.

Methods

The research is designed as a multicentred randomised controlled study. The control group receives the normal standard care provided in the study centres. The intervention group has the additional possibility of access to work-related case management.

At four points of time within a period of 30 months a standardized interview will be used to document the primary and secondary outcomes. The primary outcome is the occupational reintegration in the labour market. Secondary outcomes are abstinence rates, relapse frequency, duration of employment, receipt of disability benefits, employment in the secondary labour market, social reintegration (accommodation, debts, etc.), social benefits history and utilisation of addiction aftercare services.

Sample

The study included 320 participants from four study centres who, at the beginning of the inpatient detoxification treatment, were employable but out of work, were between 18 - 63 years old, had a first diagnosis in the area of F10-F19 (ICD 10) and were able to speak German.

Intervention

The work-related case management is localised in the detoxification clinics and is initiated during rehabilitation. Based on a detailed occupational analysis, this initial phase serves as preparation and introduction to the measures required for employment integration. The intention is during rehabilitation to begin cooperation with relevant contact persons in the employment services and in the aftercare treatment for addicts. Case management accompanies the patient for up to 12 months after rehabilitation and aims at bridging the gap between the interfaces in the aftercare phase by coordinating the employment integration and advising the work sectors concerned. In addition, the persons concerned receive counselling and coaching to assist them in re-entering the labour market, thus significantly improving the reintegration of unemployed addicts following rehabilitation treatment.

Expected results

After a period of 12 months, a difference of 28 percentage points between the intervention and control groups is expected for the integration in employment structures (primary and secondary labour markets and qualification measures). 

Twenty-four months following discharge from the detoxification clinic, it is expected that 15 % more of the participants in the intervention group will have re-entered the primary labour market (employment ≥15 hrs/week) than in the control group.

Supportive Cancer Care Networkers (SCAN)

Short title

  • SCAN

Period

  • 02/2012 – 12/2015

Leadership

  • Alexander Bauer 

Staff members

  • Dr. Stephanie Boese
  • Eva-Maria Fach

Associate partners

  • Institute of Medical Epidemiology, Biostatistics, and Computer Science, Martin-Luther-University Halle-Wittenberg (PD Dr. O. Kuß)

Support

  • Federal Ministry of Education and Research (SCAN: 01GY1143)

Project execution

  • University Hospital Halle, Faculty of Medicine, Martin Luther University Halle-Wittenberg
  • HELIOS Hospital Sangerhausen
  • Deaconess Hospital Dessau gGmbH
  • Carl-Basedow-Hospital Saalekreis
  • Harz-Hospital Wernigerode Blankenburg GmbH
  • Hospital Bernburg GmbH

Abstract

Background

Longer survival and progress in cancer medicine will probably result in a definite increase in care demands from patients with colorectal cancer during the coming years (von der Schulenburg et al., 2010; Sehlen et al., 2009). However, in spite of the drastic improvement in diagnostics and medicinal symptom management, progress regarding the life expectancy of patients has still been comparatively low (Adler et al., 2007). Cross-sector management of patients with curative therapy objective is still problematic, starting at the primary therapy, rehabilitation and maintenance therapy and continuing to include support in coping with side effects of the therapy. The steps described in the S3 guideline (Schmiegel et al., 2008) concerning inpatient diagnostic, neoadjuvant chemoradiotherapy, surgical resection, adjuvant chemotherapy and rehabilitation necessitate numerous interfaces entailing complex courses of treatment for both patients and professional staff. For instance, 30% of the eligible patients still do not pay any notice to adjuvant chemotherapy (Etzioni et al., 2008; Grothey et al., 2002), although many studies have shown that a significantly longer life expectancy is proven and although the S3 guideline explicitly recommends adjuvant therapy for suitable patients with colorectal cancer (Schmiegel et al., 2008; von Wichert et al., 2007).

Question

The aim of the planned study is to improve the networking between in-patient and outpatient service providers in order to counteract existing interface problems. The main question is therefore how can the service providers dealing with care for cancer patients be better supported so that more suitable patients accept adjuvant therapy than up to now, thus indirectly achieving longer life expectancy free from disease.

Methods

Design: A randomised evaluation study with longitudinal design (pre-post comparison)

Setting: Six hospitals in Saxony-Anhalt

Participants: The multicentred study will take place in southern Saxony-Anhalt and will include 700 test persons. There will be 350 participants in the control group and the 350 participants in the intervention group will receive a patient-oriented nursing intervention.

Outcomes: Accepting adjuvant therapy is the primary outcome. The sample size has been calculated based on a difference in the utilisation of adjuvant therapy, assumed to be10 % between the intervention and the standard treatment.

The following secondary outcomes will be documented in the patients’ records at the given measurement times: disease-free survival after 12 months, health-related quality of life (EORTC QLQ C30 combined with the organ-related module EORTC CR-29), patient satisfaction, care procedure (EORTC IN-PATSAT 32/ OUT-PATSAT 35)and therapy-associated clinical parameter such as anxiety/depression (distress thermometer) and burden (functionality and symptom stress with EORTC).

Intervention: Following hospital discharge, the patients in the intervention group will receive telephone counselling from specially trained staff (Supportive Cancer Care Networkers, SCAN). This entails regular documentation of relevant information such as symptom stress, organisational or logistic problems, psychological support or information requirements. In addition, patient-held records will be handed out in which therapy-relevant occurrences are to be recorded daily by means of validated tools. Thus, SCAN can enable the timely coordination of appropriate measures. 

Screening to identify job seekers in the local employment agencies and funding agencies of the Social Code II who require rehabilitation

Short title

  • SCIRE

Period

  • 10/2008 – 09/2009

Leadership

Staff members

  • Kristin Bretschneider 
  • Stephanie Schmidt

Associate partners

  • Research Association for Rehabilitation Sciences of Saxony-Anhalt and Thuringia (Forschungsverbund Rehabilitationswissenschaften Sachsen-Anhalt-Thüringen)

Support

  • German Pension Insurance Fund Central Germany

Abstract

Background

In recent decades, comprehensive research on the relationship between unemployment and health has proved that phases of unemployment are associated with poorer health and that the health status deteriorates with increasing duration of unemployment. It is also known that the health problems of unemployed people can often be attributed to chronic or progressive diseases. Analyses on early retirement showed that people who have gone from an unemployment phase into receiving benefits for reduction in earning capacity, had a significantly lower rate of obtaining medical rehabilitation beforehand. In addition, a number of studies have examined the issue, what affects the rehabilitation application of insured persons potentially in need of rehab. Aim of the proposed screening project is to examine whether the knowledge of "risk profiles" of unemployed people, to which diagnostic and employment biographical characteristics were determined in the project "Early Retirement without Rehabilitation", can be summarized together with properties related to the risk of early retirement without rehabilitation, and whether this can be used as a screening in favour of insured persons requiring rehab. The knowledge about possible rehabilitation services, the course of the disease and the recommendation for rehabilitation participation by third parties are in particular influence factors providing comprehensive evidence.

Question

Targeted outcome of the study are the conditions for an effective screening of the affected risk group and a smooth transition to a rehabilitation consultant from the employment agency or DRV, depending on the insurance conditions and the nature of the medical and / or vocational rehabilitation required. Especially direct addressing, counselling or recommendation for rehabilitation seem to be particularly conducive for "rehabilitation before pension '.

Methods

The study is:

  • A secondary analysis, used to deduce - possibly gender specific - "risk profiles" of unemployed people from the risk constellations, especially in the case of addictive disorders and mental illness; for this, data sets from the German Pension Insurance are used which provide information on retirement access .
  • A qualitative analysis of how determining rehabilitation needs currently takes place in the Service Centres of the Federal Employment Agency and of the institutions of the Social Code II.

Tasks and methods of the project are:

  1.  The development and compilation of risk constellations to - possibly gender specific - "risk profiles" of the unemployed.

Carrying out and evaluating expert interviews with consultants and heads of Service Centres of the Federal Employment Agency and the institutions of Social Code II of Saxony-Anhalt. The interviews are about the requirements (nominal pattern) and the actual behaviour regarding the collection of screening indicators of potential need for rehabilitation, and counselling for medical and vocational rehabilitation. The expert interviews are supported by the use of case vignettes in which specific professional behaviour is simulated in defined situations.An assessment of whether the screening indicators deduced from the “risk profiles” of the unemployed are to be integrated into those interview guides used by the consultants of the Service Centres, and, if applicable, recommendations for the performance of such an integration. The question of how updated knowledge from the DRV about risk profiles can be inducted regularly into the consulting routines of the service centres of the Federal Employment Agency is part of this assessment. For this, a final round of experts will be set up. With help of the “risk profiles”, screening indicators for a potential need for rehabilitation, especially for insured persons with mental illness and addictive disorders, can be deduced and can be integrated into the counselling procedures of the service centres.

Rehabilitation after stroke – between transformation and development

Short title

  • SFB 580 - C5

Period

  • 07/2004 - 06/2008

Leadership

  • Prof. Dr. Johann Behrens

Staff members

Support

  • German Research Association (Deutsche Forschungsgemeinschaft, DFG)

Institutional affiliation

  • Subproject C5 of the SFB 580 "Social Developments after Structural Change: discontinuity. tradition. structural formation." of the Friedrich Schiller University of Jena and the Martin-Luther-University Halle-Wittenberg. www.sfb580.uni-halle.de

Abstract

Questions and Aims

This study examines the various social and individual perspectives of the clients, funding agencies and service providers in outpatient and inpatient care following the adoption of West German structures. The examination takes place on the institutional level and assumes that societal differentiation and individualisation processes lead to alternating challenges in care structures, too. Based on this assumption, the study examines outpatient and in-patient rehabilitation and care in its varying relevancies for professional practice as a supportive aid, which, according to the Ninth Social Code Book, should promote and enable “Self-determination and Participation in Social Life”. Rehabilitation care and medicinal, occupational and social rehabilitation in the aftermath of a stroke are identified as an exemplary problem in healthcare.

Background and Research Status

The project concerns itself with two overlapping “challenges”: The West German rehabilitation and care institutions for coping with inclusion risks are replacing the more operationally oriented facilities in the GBR just at the very moment when demographical changes and evidence of effectiveness are becoming a challenge for the West German institutions themselves. This means that in the coming two phases of SFB there will be the chance to pursue in longitudinal perspective not only rehabilitation as inclusion through rehabilitation and care but also the development of the reform of the health and social insurance services as a response to the demographic changes.

Work plan and Methods

A double longitudinal analysis will be carried out: 1) a prospective examination of individual processes for returning to the labour market or accepting early retirement and 2) the prospective transformation of current local institutionalisations (among other things as a historical compromise of early retirement and in-patient rather than outpatient care and rehabilitation) under the pressure of demographic change and the development of cost and remuneration in the health and social services sector over the coming eight years. The empirical material is collected by means of expert interviews, supported by case vignettes (“paper patients”) and confrontation with the following representative process-produced usage data: 1) prospective data of individual processes for early retirement and (in-patient) care in all the federal states (routine data collected by the Pension Fund authorities), 2) registration and analysis of counselling discussions or rehabilitation planning with clients’ participation, 3) a longitudinal survey of rehabilitation procedures taking process data and self-information from those concerned or their relatives into account.

Transfer perspectives

Description of clients’ preferences and those of the profession staff concerned, evidence-based international framework (“best practice”), development of methods for international comparative research.

Publications

Qualitative Implementation Study "Structure and process changes in the vocational rehabilitation"

Short title

  • SGB II-Study

Period

  • 8/2006-06/2009

Leadership

Staff members

  • Marlies Hauger 
  • Cornelia Hippmann 
  • Dr. Anke Höhne 
  • Dietmar Hobler 
  • Edina Schneider 
  • Dr. Markus Zimmermann

Associate partners

  • Angela Rauch (IAB) 
  • Johanna Dornette (IAB)

Support

  • Federal Labour Agency, Federal Ministry of Economics and Labour respectively the Federal Ministry of Labour and Social Affairs

Abstract

Background

The health status of unemployed people is often worse than the health status of employed people, which is reflected in poorer chances of reintegration and therefore in an unemployment duration above average. In addition, health deteriorates with the duration of unemployment.

Thereby services promoting participation in the labour force represent an important socio-political instrument to maintain or to improve the employment opportunities of people with health problems and to support their chance for reintegration into the labour market. With the introduction of the Social Code II in 2005 extensive changes in the access to vocational rehabilitation for long-term unemployed were initiated. Cost-sponsorship and process-responsibility are now included in various labour market institutions; in the framework of the re-employment, the “ARGEs” (today’s “Jobcentres”) are responsible for managing the rehabilitation process and the employment agencies or selected local authorities bear the financial responsibility.

The research project, which was carried out on behalf of and in cooperation with the Institute for Labour Market and Employment Research (Institut für Arbeitsmarkt und Berufsforschung, IAB) places the question as to how the changes in the access paths and access conditions will develop.

Methods and Study Design

Based on a stratified sample (condition of the labour market, settlement structure and east-west differentiation), 32 expert interviews based on a manual were conducted nationwide with employment agents, case managers and rehabilitation consultants in the ARGEs, selected local authorities and employment agencies. Using four specific defined case vignettes, exemplary case scenarios were discussed with the interlocutors. Thus, the variance in the various institutions dealing with the support and placement of job seekers with health problems could be detected and analyzed comparatively using a qualitative content analysis.

Results

The new regulations of the Social Code II have extensive legal consequences for vocational rehabilitation too (see Schubert et al. 2007). Firstly, in their implementation the maxim of rapid (re-)integration (SGB II) often precludes sustainable inclusion (SGB IX). Moreover, the learned profession loses much of its importance under Social Code II, as this is no longer solely the base of the case management; any other activity is considered to be reasonable. Furthermore, clearly influenced by the now combined group of unemployed people and people needing welfare, a change in the client structure has been observed (increased number of more extensive individual problems and mental illness). Under the criterion of individual rehabilitation ability, this also has an effect on access to vocational rehabilitation.

In addition, it is reported that affected persons often take no advantage of rehabilitation services for financial reasons, because financial security during a rehabilitation measure ranges around the subsistence level.

Moreover, it must be noted that with the Social Code II and the distribution of competences a medical expertise acquires a different significance.

Discussion

The aspects mentioned above show a clear impact on the access to vocational rehabilitation for long-term unemployed people. The new legal frameworks represent a big challenge for vocational rehabilitation achievements altogether and also for the professional protagonists concerned with the access to rehabilitation measures.

The specific problems and health burden profiles of affected persons lead to a shift between the (in Social Code II extensive) "general" measures and the "special" achievements, which include vocational rehabilitation. Thus, providers for "general" achievements of labour market integration also promise that they can take specific health problems into account, and are also less expensive.

By focusing on finding jobs rapidly in accordance with the comprehensive acceptability regulations (opportunity to relegate to another "compatible" activity) and on individual motives for non-use, the specific vocational rehabilitation sector could lose much of its importance. As a result, the socio-political expenses would decrease significantly, but the chances of a sustainable reintegration of those affected often decrease, too, if specific qualification offers are not forthcoming.

Publications

  • Rauch, A.; Dornette, J.; Schubert, M.; Behrens, J. (2008): Berufliche Rehabilitation in Zeiten des SGB II. IAB-Kurzbericht 25/2008. 
  • Schubert, M; Behrens, J.; Höhne, A; Zimmermann, M. (2008): Verliert berufliche Rehabilitation bei Langzeitarbeitslosigkeit an Bedeutung? Prozesse und Einflussfaktoren des Leistungszugangs. In: DRV (Hrsg.): Evidenzbasierte Rehabilitation – zwischen Standardisierung und Individualisierung, Bad Homburg, 246-248. 
  • Dornette, J.; Rauch, A; Schubert, M.; Behrens, J.; Höhne, A.; Zimmermann, M. (2008): Auswirkungen der Einführung des Sozialgesetzbuches II auf erwerbsfähige hilfebedürftige Personen mit gesundheitlichen Beeinträchtigungen. In: Zeitschrift für Sozialreform, 54, 1, 79-96. 
  • Schubert, M.; Behrens, J.; Hauger, M.; Hippmann, C.; Hobler, D.; Höhne, A.; Schneider, E.; Zimmermann, M. (2007): Struktur- und Prozessänderungen in der beruflichen Rehabilitation nach der Einführung des SGB II. In: Dornette, J; Rauch, A: Berufliche Rehabilitation im Kontext des SGB II. IAB-Bibliothek, 309, 7-87. 

Specialised nurses to support informed shared decision making in oncology

Short title

  • SPUPEO

Period

  • 01.03.2012 – 30.06.2017

Project leader

Staff members

  • Birte Berger-Höger, (B.Sc., M.Ed.)
  • Dr. phil. Katrin Liethmann (Department of Pediatrics and Institute of Medical Psychology and Sociology, University Medical Center Schleswig-Holstein)
  • Univ.-Prof. Dr. med. Ingrid Mühlhauser (Unit of Health Sciences, MIN Faculty, University of Hamburg)

Associate partners

  • Unit of Health Sciences, MIN Faculty, University of Hamburg

Funding

  • The study was funded by the German Federal Ministry of Health within the National Cancer Action Plan (Funding code: NKP – 332 – 054). 

Abstract

Background

Women with breast cancer want to participate in treatment decision making. Guidelines have confirmed the right of informed shared decision making. However, previous research has shown that the implementation of informed shared decision making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision making programme for women with primary ductal carcinoma in situ (DCIS). The programme provides decision coaching for women by specialised nurses and aims at supporting involvement in decision making and informed choices.

In this trial the informed shared decision making programme will be evaluated in breast care centres.

Methods

A cluster-randomised controlled trial will be conducted to compare the informed shared decision making programme with standard care. The programme comprises an evidence-based patient decision aid and training of physicians (two hours) and specialised breast care and oncology nurses (four days) in informed shared decision making. 16 certified breast care centres will be included recruiting 192 women with primary DCIS.

Primary outcome is the extent of patients´ involvement in shared decision making assessed by the MAPPIN-Odyad (Multifocal approach to the ‘sharing’ in shared decision-making: observer instrument dyad). Secondary endpoints include the submeasures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient, MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters.

It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients’ involvement in decision making, informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be carried out.

Trial registration

  • Current Controlled Trials ISRCTN46305518, date of registration: 05.06.2015

Publications

Evaluation of the pilot project PHTS Telemedicine in chronic heart failure

Short title

  • Telemedicine

Period

  • 7/2007 - 3/2008

Leadership 

  • Prof. Dr. Margarete Landenberger (project leader) 
  • Dr. Anke Höhne (scientific leader)

Staff members

  • Dr. Alexander Bauer

Associate partners

Support

  • IKK gesund plus

Abstract

Background

Taking care of chronically ill people is one of the biggest challenges of the German health system. Chronic heart failure (cardiac insufficiency) was, with a share of 5.7 percent of all deaths in Germany in 2006, the third leading cause of death. All in all, cardiovascular diseases are the first cause of death in Germany (see Statistisches Bundesamt, 2006).

Seen from an economic perspective, chronic heart failure is also a significant factor. The percentage of the treatment costs for this disease is estimated to be up to two percent, or 4.8 billion Euros, of the nation’s total health expenses (see Szucs & Sokolovic, 2000). In addition to this, incidence and prevalence for chronic heart failure in recent years have increased steadily internationally and will continue to rise (see Yusuf et al., 2000).

Recently, telemedical care structures have increasingly been in the focus of all those involved in German healthcare, as they are a possible answer to several problem areas in caring for the chronically ill.  Telemedical care allows a regular monitoring of relevant vital parameters and is an economically favourable variant in the care of patients with chronic heart disease. It can also help counteract an early deterioration of health status and at long-term the progredience of the chronic disease.

Questions

The research project has two main issues:

1) How do the patients, who  receive telemedicine, evaluate the quality of care?

The IKK gesund plus offers since 2005, as part of a pilot project for insured persons with chronic heart failure, a telemedical care provided by the PHTS company (Personal HealthCare Telemedicine Services, Düsseldorf, www.phts.de). Relevant medical vital signs (blood pressure, weight) are collected every day with the corresponding medical units and forwarded by telephone to PHTS, where they are entered in an electronic patient file and then evaluated. This service also includes the possibility of obtaining medical advice in the telemedicine centre 24hours a day. The questionnaire filled out by the program participants  focuses on aspects of use and satisfaction with the quality of telemedicine services provided by PHTS. To check whether the telemedical care is seen from the patient's perspective as an improvement to the regular supply, a control group design is realized. In addition to N = "108" tele-care patients, N = "303" cardiac patients receiving standard care will be included in the survey as a comparison group. Specific questionnaires for each group have been developed which for the most part include identical sets of questions and expressions, thus making the results of the two groups of patients comparable.

2) Is it possible to reduce the treatment costs for patients with chronic heart failure by using telemedical support?

Part of a health economic analysis based on routine data by the IKK gesund plus examines whether the telemedical care leads to a difference in costs (use of emergency care, the number, duration and cost of inpatient hospital stays, frequency of outpatient visits and medication costs). First of all, the cost-income ratio before and during the participation in the telemedicine program is reviewed. Secondly, an analysis shows how the telemedical care affects the costs, compared to the regular care. The health economic analysis is implemented as a cost-cost analysis, as a cost-effectiveness analysis and a cost-utility analysis.

Methods

Based on the control group design, insured persons are requested to fill out a questionnaire which is then evaluated to find out whether the medical and economic objectives of telemedical support can be achieved. The questionnaire includes questions on improvement in the quality of life, awareness of risk symptoms and associated sustainable change in lifestyle, as well as the medical outcomes reducing the risk of subsequent impairment and worsening of cardiac health. 

The economic perspective is that telemedicine should contribute to a decrease in hospitalization rate and duration of hospital stay, and ultimately lead to a significant cost reduction. The economic aspects will be examined by a comparative analysis of the routine data collected by the IKK gesund plus from selected patients for the period 2004-2006 (health economic evaluation).

Discussion

The objectives of the telemedical care for insured persons with chronic heart disease can be summarized as follows:

  • Decrease in hospitalization rate
  • Reduction of the duration of hospital stay
  • Reduction of overall costs for hospitals and medical practices
  • Reduction of subsequent medical impairment
  • Increase of the health-related quality of life
  • Increase of the customer care satisfaction
  • Improvement in disease-related knowledge

Length of stay in the nursing professions in Rhineland-Palatinate

Short title

  • ViP

Period

  • 2005 - 2008

Leadership

Staff members

  • Dr. Rolf Müller

Associate partners

  • GEK

Support

  • Ministry of Labour, Social Affairs, Health, Family and Women in Rhineland-Palatinate

Effective strategies of a communicative approach to dementia patients and cognitively impaired persons

Short title

  • WISDE / T6

Period

  • 02/2007 - 01/2010

Leadership

  • Prof. Dr. Johann Behrens
  • Katharina Sadowski

Staff members

Associate partners

  • Facilities for inpatient long-term care in Saxony-Anhalt and Saxony
  • Facilities for inpatient long-term care in Hesse and Bavaria

Support

  • BMBF

Abstract

Background

Dementia is one of the most frequent and serious psychiatric illnesses of old age. At present there are an estimated 953,000 persons in Germany suffering from a moderate to severe dementia disease; around 200,000 new patients are diagnosed every year. In the final stage of the illness institutionalised care for those afflicted becomes particularly important: an estimated 40% of all dementia patients in Germany are cared for in nursing homes (Bickel 1995, 2001). According to a BMG study, approximately 69% of nursing home residents suffer from dementia (see Hirsch/Kastner 2004; BMFSFJ 2006).

Life for those afflicted and for their carers is made more difficult, not only by the cognitive impairment but above all by the secondary symptoms of dementia such as apathy, anxiety, depression, aggressiveness and challenging behaviour (see Wächter 2003). According to Swearer (1988) nearly 80% of those afflicted shows signs of challenging behaviour. Difficulties in making oneself understood or in being able to understand impede the communicative approach to the environment and vice versa, whereby dementia can be seen as a mutual communication problem. The afflicted persons and their carers frequently move on different levels of interpretation, so that the approaches remain sealed and unattainable. These different interpretations of actions and statements appear to threaten the own identity and integrity in a “crazy” world. 

By using and activating remaining resources, it is possible for a carer to find scope for interpretation so that a relationship with the afflicted person can be formed, enabling mutual communication. Depending on the severity of the illness, resources such as biographical memories, experiences, abilities and skills can be of use as well as somatic and emotional perceptions. There are a large number of interventions available for activating these resources for persons with dementia. However, interaction with those concerned and also the surroundings, whether special, functional or temporal, play a considerable role.

Question

Various care interventions are implemented in very different ways, sometimes even euphorically, but mostly solely based on internal evidence. This complicates both legitimation in front of decision-makers and achieving a consistent level of quality in the practice. Practical experience has shown that a great demand exists for identifying suitable care interventions for interacting with dementia patients and also for identifying their efficacy, thus providing external evidence documents.

WOUNDSS - Wound dressings for wounds undergoing primary healing: A Systematic Review

Short title

  • WOUNDSS

Period

  • 04/2010 - 03/2011

Leadership

Staff members

  • Almuth Berg
  • Dr. Steffen Fleischer
  • Dr. Susanne Unverzagt (IMEBI, Martin Luther University Halle-Wittenberg)
  • Dr. Oliver Kuß (IMEBI, Martin Luther University Halle-Wittenberg)

Associate partners

Support

  • German Federal Ministry of Education and Research

Abstract

Following an operation, surgical wounds are normally protected by dressings in order to keep the incision area dry and to minimise contamination by microorganisms. On the one hand, the incision area can become contaminated with dangerous germs when a dressing is removed early on in order to palpitate and inspect the wound; on the other hand, the fibrinous closure of a wound undergoing primary healing occurs just shortly after the operation so that these germs cannot penetrate the wound. Several studies suggest that leaving wound dressings on for longer periods does not bring any advantages.

The results of this systematic review could contribute to quality assurance in healthcare.