Gesundheitswesen最新文献

Nursing care insurance companies in Germany have the legal mandate to develop measures to strengthen the health resources of residents of nursing homes. The present study aimed to examine a mindfulness-informed mind-body intervention (on-site and app) adapted for residents in nursing homes regarding their effect on health-related parameters.A pilot study (DRKS00030409) was carried out with three groups in twelve nursing homes (RCT). There was an on-site intervention in a group (O), an individual app application with technical support (A) and a passive control group (C). The participating residents (n_O=28; n_A=29; n_C=19) were cluster-randomized. Before, after, and three months after the intervention period (December 2022 - January 2023), among other things, subjective well-being (WHO-5, primary outcome) and mindfulness (KIMS-D, including four subscales) were assessed. Differences within and between study groups and participants with different participation intensity were tested. In addition, a sensitivity analysis was carried out with people who did not have severe cognitive impairments at all three survey times.Indications of differences were found in subjective well-being during the intervention period between the study groups of medium size. While a decrease was observed in the control group, there was no change in the intervention groups. When the intensity of participation was taken into account, the difference between the groups became clearer. In addition, the app group showed an increase in mindfulness (subscale Observing) immediately after the intervention compared to the control group.Although further studies with larger samples are needed, the results already indicate that the intervention improves the well-being and mindfulness of the target group. Individual support could explain the higher effectiveness in the app group. The influence of the Covid-19 pandemic and the season (winter) on effectiveness must also be examined.

In 2021, a transitional form of housing for outpatient weaning was certified based on paragraph 17 of the Bavarian Law on Quality Assurance of Care and Housing. In order to get an overview over the research field, we carried out a scoping review. In particular, we focussed on two research questions: 1. What are the factors that contribute to the quality of life of people receiving artificial respiration in an outpatient setting? 2. Which factors necessitate weaning in an outpatient setting and what are the conditions that facilitate weaning?Seven data bases were searched with defined search terms. After two extractions, 401 matches were found. On the basis of an analysis of these abstracts, the results were systematically categorized. In order to answer the research questions, the topic "intensive and respiration care" was chosen for closer analysis; 120 texts were analysed more thoroughly.Results showed that we do not have sufficient data to answer the research questions in a satisfactory manner. The quality of life of ventilated people was found to be heterogenous, but self-determination and empathetic communication between the relevant institutions, on the one hand, and patients, on the other, clearly enhanced it. What was also beneficial was the inclusion of patients in social networks. What was obviously negative was the lack of competent personnel. It was also observed that the weaning potentials in outpatient care were not sufficiently made use of. Intersectoral care concepts are being discussed.The issues of intensive outpatient care as well as weaning and the question of how a self-determined and satisfactory life can be achieved have hardly been evaluated. Moreover, the terms quality of life and self-determination in this setting have hardly been operationalized. Further research is necessary. Nonetheless, self-determination appears to contribute to the life quality of seriously ill patients.

The objective of the study is to provide a comprehensive description and analysis of the current state of research on communication between general practitioners and deaf patients, with particular reference to the utilisation of sign language and to identify research gaps in the field of communication with deaf patients in general practice.The study was designed as a scoping review in accordance with the methodological standards established by Arksey and O'Malley (2005). A search was conducted across the CINAHL, PubMed and Web of Science databases. The study incorporated research conducted on the provision of general practice care to deaf patients who use sign language. The data extraction process was conducted on 12 April 2022, with a subsequent follow-up search conducted on 27 February 2024. The publications were assessed in a blinded manner.Following the exclusion of duplicates, a total of 2,060 publications were subjected to review, and the full texts of 86 search results were subsequently examined. The review incorporated a total of seven studies, of which four employed quantitative survey methodologies and targeted physicians (2), deaf patients (1), or both physicians and deaf patients (1). Two qualitative studies were conducted, one focusing on deaf people and the other on sign language interpreters. One study utilised a mixed-methods approach and focused on deaf patients. In total, 316 deaf patients, 355 doctors, and 19 sign language interpreters were surveyed. Five topics were identified for further investigation: communication problems as perceived by deaf patients, communication from the perspective of general practitioners, strategies for improving communication, the use of sign language interpreters, and the consequences of communication barriers. The extant literature suggests a paucity of knowledge among general practitioners in dealing with their deaf patients. Strategies for overcoming communication problems are considered inadequate; sign language interpreters are rarely used in general practice.Communication between general practitioners and deaf patients is considered inadequate because communication aids are either unavailable or unsuitable and untrained lay interpreters are used. There is an absence of reliable statistics concerning the utilisation of qualified sign language interpreters in general practice within the German healthcare system. This gap should prompt further research efforts.

The German pension insurance continuously supervises the quality of disability pension expert opinion reports by a standardized peer review process. The current study analyses the concrete reasons of the peers for non-reproducibility of sociomedical judgments concerning performance capability in these expert opinion reports.Free-text comments documented by peers in the peer review process 2021 of the German pension insurance with respect to shortcomings in the reproducibility of sociomedical judgments (n=569) were evaluated in a structured-inductive manner using Mayring's qualitative content analysis.Contentwise the reasons for the non-reproducibility of sociomedical judgments in these expert opinion reports comprise recurrent shortcomings in anamnesis/clinical assessment, specifically with respect to confirmation of diagnosis, as well as gaps/inconsistencies in the chain of arguments concerning sociomedical evaluation of performance capability.Identification of these reasons concretizes the complexity of the sociomedical evaluation process, allows sharpening of the content expectations towards the expert consultants and further sensitizes readers to assessment of the sociomedical key aspects in expert reports.

The present study aimed to gain insight into the psychotherapeutic care situation for people over the age of 65 in the cities and districts of Bad Kissingen, Haßberge, Rhön-Grabfeld, and Schweinfurt, Germany. Additionally, it examined indicators and potential reasons for gaps in care and identified possible approaches to improving psychotherapeutic services for older adults.For this purpose, surveys were conducted with n=31 licensed psychotherapists and employees of social psychiatric services, as well as n=12 general practitioners from the studied regions. Data were collected through questionnaires featuring open, semi-open, and closed questions, supplemented by additional interviews.The psychotherapeutic care for older adults in the region was largely assessed as inadequate. Furthermore, older adults were underrepresented in outpatient psychotherapy. Key barriers to accessing psychotherapy included lack of knowledge about mental illnesses and their treatment, as well as fears of stigmatization among older patients. General practitioners primarily faced time constraints and insufficient networking, while psychotherapists cited the lack of therapy slots and limited experience and knowledge in treating older patients as the greatest challenges.The study confirms the suspected discrepancy between the need for psychotherapy and its actual utilization among people over 65 in the Mainfranken region. The group of very old individuals over 85 seems to be particularly affected by this undersupply. To improve the care situation, both structural measures-such as expanding therapy capacities and creating low-threshold services-as well as information and networking initiatives should be implemented.

Early involvement in care planning is essential for people with dementia. The concept of advance care planning (ACP) offers a promising opportunity to consider their individual wishes for care and treatment at the end of life. Aim The aim of this review was to provide an overview of the current evidence on advance care planning for people with dementia.We conducted a systematic literature search in the databases Medline, PsycINFO, Scopus, CINAHL, and CENTRAL for articles published between January 2017 and April 2023. The study quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP).Seven studies were included in the qualitative analysis. The studies demonstrated positive effects of Advance Care Planning on various domains for individuals with dementia and their caregivers. However, the included RCTs exhibited significant heterogeneity in terms of methodology, quality, and measured outcomes.Videos and training can be effective tools for successfully implementing ACP for individuals with dementia and their caregivers. However, studies with stringent intervention criteria and standardized outcomes are needed to conclusively assess the effectiveness of Advance Care Planning.

The Digital Healthcare Act introduced digital health applications (DiGA) as a supplement to standard care in Germany in 2019. These applications offer potentially scalable treatment options in the field of mental health, which could be particularly important in times of crisis. There is therefore a considerable need for research to investigate how well DiGAs are known, how frequently they are used and how open people are to their potential use as an addition to traditional care. The aim of the present study was to investigate the awareness, use and acceptance of DiGAs in the general adult population living in GermanyData collected were part of the COVID-19 Snapshot Monitoring Study in Germany in June 2021. The representative sample comprised n=1011 participants (n=506 women (50%), n=505 men (50%), mean age: 44.8 years, standard deviation:15.7). Using logistic and multiple regression models, associations between sociodemographic variables and awareness and use of DiGA as well as willingness to use DiGA were analyzed. Furthermore, reasons for non-use and sources of information about DiGA were analyzed.The majority of participants were not familiar with DiGA, and only a few had already used a DiGA. In principle, however, many participants were open to using DiGA. Age was the only significant predictor of awareness and use: older people were more likely to know and use DiGA. The willingness to use and preference of DiGA in comparison to face-to-face psychotherapy was influenced by education, health awareness and self-rated mental health. Higher education and better mental health reduced the willingness to use DiGA, while higher health awareness increased it.Overall, this study paints a complex picture of the potential and challenges of establishing DiGA in existing care provision. The goal should be to consider, develop, and implement appropriate age- and target group-specific formats for informing and educating people about DiGA, contributing to the enhancement of health literacy in the search for suitable healthcare services.

Sleep disorders, particularly insomnia, are a common reason for consultation in general practice. Among the approved treatment options are benzodiazepines (BZ) and benzodiazepine receptor agonists (BZRA). However, these medications carry a risk of dependence. The extent to which the risk of medication dependence influences the treatment decisions of general practitioners (GPs) is unclear. This study aimed to explore the spectrum of awareness regarding dependency potential of these drugs and prescribing practices.As part of an exploratory qualitative interview study, 17 general practitioners from the districts of Tübingen, Reutlingen, and Zollernalb were interviewed. Data analysis was conducted using qualitative content analysis according to Kuckartz. A subsequent cross-analysis focused on addiction medicine aspects.Seven relevant dimensions with an addiction medicine focus emerged: (1) assessment of substances, (2) patient education, (3) prescribing in the context of expectations from patients, relatives, and caregivers, (4) prescription type, (5) older patients, (6) younger patients, (7) duration of prescription, and (8) assumption of responsibility. It became evident that dimensions 1-6 should be considered influencing factors for the assumption of responsibility.Clear differences in the assumption of responsibility regarding the prescription of BZ/BZRA for sleep disorders in general practice were observed. The influencing factors identified could serve as starting points for promoting responsibility in prescribing. In this context, information and training on addiction medicine aspects could play a crucial role.

Embryotox.de offers evidence-based information on drug safety during pregnancy and lactation free of charge and independent from pharmaceutical industry. There are more than five million users per year. Utilization of embryotox.de in routine healthcare was investigated in a mixed-methods study funded by the G-BA Innovation Fund. The following sub-analysis focuses on the use by pharmacists.User feedback was obtained by two different online questionnaires (multiple choice options or ratings on a Likert Scale ranging from 0 "not at all" to 10 "completely"). Questionnaire 1 included questions on user characteristics, clinical circumstances, comprehensibility and consequences of use, while questionnaire 2 asked about typical situations of use and applications of retrieved information. For this analysis, all questionnaires answered by pharmacists were evaluated using descriptive statistics.A total of 550 pharmacists completed online questionnaire 1, 87.3% of whom (n=480/550) worked in community pharmacies. Medication for cough and cold symptoms (19.3%, n=106/550) and non-opioid analgesics (16.9%, n=93/550) were most frequently inquired. 57.1% (n=314/550) reported that their risk perception of a given drug had changed after reading the respective fact sheet. Pharmacists' mean rating of fact sheet comprehensibility was 9.25 (Likert scale from 0 to 10). 79 pharmacists completed online questionnaire 2. 93.7% (n=74/79) considered embryotox.de helpful for informing and, if necessary, reassuring worried patients. They also used embryotox.de to pass on selected information to patients (79.7%, n=63/79), to check prescription drugs before dispensing (57.0%, n=45/79) and to consult with prescribing doctors in cases of critical medications (58.2%, n=46/79).Community pharmacists obtain relevant information from embryotox.de on risk and safety of OTC and prescription drugs in pregnancy and lactation. Embryotox.de thus supports pharmacists in counselling pregnant and breastfeeding patients and ensuring safe and rational drug treatment.