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Fragestellung: Mit der Studie soll die Nutzer- bzw. Patientensicht auf das Angebot der Psychosomatischen Sprechstunde im Betrieb (PSIB) in Ulm näher untersucht werden mit Schwerpunkten auf der Niederschwelligkeit des Angebots, Befürchtungen und Hemmnisse sowie Erfahrungen mit bzw. über psychische Erkrankungen. Methodik: Es wurden mit 19 Patienten der PSIB telefonische, leitfadengestütze, problemzentrierte Interviews durchgeführt, zusätzlich soziodemographische Daten der Befragten aus einer parallel erhobenen Basisdokumentation verwendet. Die Interviews wurden aufgezeichnet, transkribiert und mithilfe der inhaltlich strukturierenden Inhaltsanalyse nach Kuckartz analysiert. Ergebnisse: Die Niederschwelligkeit der PSIB wurde auch von den Teilnehmern der Studie berichtet bei wenig bestehenden Befürchtungen und Hemmnissen. Es zeigten sich große Unterschiede im Umgang mit der eigenen Erkrankung, dem Besuch der PSIB sowie dem Umgang des beruflichen und privaten Umfelds mit psychischen Erkrankungen.

Patients from migrant descent access inpatient psychosomatic rehabilitative care less and achieve less treatment success than patients from the host populations. They are confronted with different process barriers in the healthcare system which combined with individual barriers can inhibit successful treatment. Studies have shown that working with migrant patients may also be challenging for healthcare providers.This study aims to assess and compare barriers and resources faced by migrant and non-migrant patients during their treatment in inpatient psychosomatic rehabilitative care. Also, the aim is to assess and compare barriers and resources faced by healthcare providers in treating migrant and non-migrant patients in order to identify barriers and resources specific to working with migrant patients.A total of 77 semi-structured interviews were conducted (20 migrant and 19 non-migrant patients as well as 14 migrant and 24 non-migrant healthcare providers). Data were transcribed and analyzed applying the method of qualitative content analysis (Mayring) with inductive categories.Migrant and non-migrant patients stated that they profit from the treatment in inpatient psychosomatic rehabilitative care. The greatest barriers for both migrant patients and healthcare providers are language barriers, cultural differences, differences in expectations regarding the treatment and limited organizational cultural competences. As far as organizational cultural competences are implemented, they are profitable for migrant patients and non-migrant healthcare providers. However, migrant healthcare workers seem responsible for implementing culturally competent care and suffer from increased workload.Patient/innen mit Migrationshintergrund nehmen Angebote der psychosomatischen Rehabilitation seltener in Anspruch und erreichen niedrigere Behandlungserfolge als Patient/innen ohne Migrationshintergrund. In der Gesundheitsversorgung begegnen Patient/innen mit Migrationshintergrund verschiedenen Prozessbarrieren und individuellen Hindernissen, die die Behandlung erschweren können. Studien haben gezeigt, dass auch für Mitarbeiter/innen in Gesundheitseinrichtungen die Behandlung von Patient/innen mit Migrationshintergrund herausfordernd sein kann.Ziel dieser Studie ist es, Barrieren und Ressourcen von Patient/innen mit und ohne Migrationshintergrund zu erheben, die sie während ihrer Behandlung in psychosomatischen Rehabilitationskliniken erleben, und miteinander zu vergleichen. Ferner sollen die Barrieren und Ressourcen von Mitarbeiter/innen mit und ohne Migrationshintergrund in der Behandlung von Patient/innen mit und ohne Migrationshintergrund erfasst und ebenfalls verglichen werden.Es wurden insgesamt 77 semi-strukturierte Interviews geführt (20 Patient/innen mit Migrationshintergrund und 19 ohne, sowie 14 Mitarbeiter/innen mit Migrationshintergrund, 24 ohne). Die Daten wurden transkribiert und nach der Methode der zusammenfassenden qualitativen Inhaltsanalyse nach Mayring mit induktiver Kategorienbildung ausgewertet.Patient/innen mit und ohne Migrationshintergrund profitieren nach eigenen Angaben von der Behandlung in psychosomatischen Rehabilitationskliniken. Die wichtigsten Barrieren für Patient/innen mit Migrationshintergrund und Mitarbeiter/innen sind Sprachbarrieren, kulturelle Unterschiede, divergierende Erwartungen sowie die eigenschränkte interkulturelle Öffnung der Rehabilitationskliniken. Sofern diese implementiert ist, profitieren Patient/innen mit Migrationshintergrund und Mitarbeiter/innen ohne Migrationshintergrund von ihr, während v. a. Mitarbeiter/innen mit Migrationshintergrund diese gewährleisten und unter Mehrbelastungen leiden.

Simulation-based teaching is gaining increasing importance in veterinary education worldwide and is by now an integral part of all German veterinary educational institutions in the form of Skills Labs. Students and teachers of the University of Veterinary Medicine Hannover, Foundation (TiHo) showed a good acceptance for the establishment and curricular use of a Clinical Skills Lab (CSL). This study will now examine the perspectives of non-university stakeholders in order to assess the acceptance of such a facility among clinicians. In addition, experiences in implementing a CSL in veterinary teaching are taken into account by interviewing experts.Semi-structured guided interviews were conducted with alumni of the TiHo, senior veterinarians from various German clinics and practices and leading experts from some of the largest veterinary CSLs worldwide.The interviews revealed a need for improvement in the clinical-practical training of veterinary students among senior veterinarians and alumni. Respondents could imagine that teaching in the CSL may play a major role in this. Overall, the participants pleaded for a mandatory implementation of simulation-based teaching in the curriculum.The study suggests that the training of clinical-practical skills of veterinary students should be continuously adapted to the requirements of the veterinary profession in a clinical environment. Non-university stakeholders seem to support the use of a CSL to improve these skills and encourage its further implementation in the curriculum.Die simulationsbasierte Lehre hat in der tiermedizinischen Ausbildung weltweit immer mehr Bedeutung und ist mittlerweile in Form von Skills Labs ein fester Bestandteil an allen deutschen tiermedizinischen Bildungsstätten. Studierende und Dozierende der Stiftung Tierärztliche Hochschule Hannover (TiHo) zeigten eine gute Akzeptanz für den Aufbau und die curriculare Nutzung eines Clinical Skills Lab (CSL). Weiterführend sollen nun die Perspektiven hochschulexterner Interessenvertreter untersucht werden, um die Akzeptanz einer solchen Einrichtung unter klinisch tätigen Tierärzten/-innen zu erfassen. Zusätzlich werden durch die Befragung von Experten/-innen deren Erfahrungen bei der Implementierung eines CSL in die tiermedizinische Lehre berücksichtigt.Es wurden semistrukturierte Leitfadeninterviews mit Alumni der TiHo, mit leitenden Tierärzten/-innen verschiedener Kliniken und Praxen in Deutschland sowie mit leitenden Experten/-innen einiger der größten tiermedizinischen CSLs weltweit durchgeführt.Die Interviews zeigten einen Bedarf bei leitenden Tierärzten/-innen und Alumni nach einer Verbesserung der klinisch-praktischen Ausbildung von Tiermedizinstudierenden und die Befragten konnten sich vorstellen, dass die Lehre im CSL hierbei eine tragende Rolle spielen könne. Insgesamt plädierten die Teilnehmenden für eine verpflichtende Implementierung simulationsbasierter Lehre im Curriculum.Die Untersuchung legt nahe, dass die Ausbildung klinisch-praktischer Fertigkeiten von Studierenden der Tiermedizin laufend an die Anforderungen der klinischen tierärztlichen Berufstätigkeit angepasst werden sollte. Hochschulexterne Interessenvertreter scheinen den Einsatz eines CSL zur Verbesserung der entsprechenden Fertigkeiten zu unterstützen und eine weitergehende Implementierung in das Curriculum zu befürworten.

Work-related interventions and alliances between healthcare institutions and companies that aim to support employees with common mental disorders (CMD) returning to work are still quite rare in Germany. The present study examines a small sample of existing alliances and interventions with the aim to describe their cooperation forms and treatment approaches, to identify their strengths and weaknesses, and thus to provide guidance for their further development and dissemination.Five alliances/interventions were selected on the basis of a web search. Subsequently 11 group discussions and 17 qualitative interviews with involved health care professionals and occupational stakeholders (n=44) as well as employees with CMD (n=17) were conducted and evaluated by documentary method and qualitative content analysis.The examined interventions follow either a person oriented self-management or a systemic case management approach. The self-management approach focusses on what has to be done by the person him-/herself to get back to work (focus on individual adaption). The systemic approach additionally asks for workplace adaption. Which approach is chosen, depends inter alia on the involved actors' preconscious frames of orientation, i. e. their assumptions regarding the modifiability of work-related risk factors. The main strength of the self-management approach lies in its ability to reinforce self-care, its main shortcoming in the one-sided focus on individual adaption and the risk of individualizing the disease, its causes and coverage. The systemic approach seems to be more sustainable through the combination of individual and workplace adaptions. The challenge here is to find an appropriate balance between individual self-care and occupational health care.The findings show how the RTW of employees with CMD can be supported by more collaborative and work-related interventions. However, they also reveal limits and barriers of existing interventions and therefore provide useful hints for their further development and dissemination.Noch immer bilden Kooperationen zwischen medizinisch-therapeutischen Einrichtungen und Betrieben sowie arbeitsplatzbezogene Interventionen für Beschäftigte mit psychischen Krisen und Erkrankungen Ausnahmen in der nationalen Versorgung. Die vorliegende Studie untersucht einige dieser Ausnahmen mit dem Ziel, ihre Vernetzungsformen und (Be-)Handlungsansätze zu beschreiben, ihre Stärken und Grenzen zu identifizieren und so wichtige Hinweise zu ihrer Weiterentwicklung und Dissemination zu geben.Auf Basis einer Onlinerecherche wurden 5 Angebote ausgewählt. Anschließend wurden 11 Gruppendiskussionen und 17 Interviews mit den in diese Angebote involvierten betrieblichen und überbetrieblichen Akteuren (n=44) sowie mit Betroffenen (n=27) durchgeführt und mittels dokumentarischer Methode der Interpretation bzw. qualitativ-inhaltsanalytisch ausgewertet.Es ließen sich 2 (Be-)Handlungsansätze und Vernetzungsformen identifizieren. Ein individuumsbezogener Selbstmanagementansatz und ein systemischer Fallmanagementansatz. Im Fokus des ersten Ansatzes steht die Frage, was der Betroffene tun muss, um an seinen Arbeitsplatz zurückkehren zu können, der zweite Ansatz fragt zusätzlich danach, was hierfür am Arbeitsplatz getan werden kann. Geprägt werden die Ansätze u. a. durch die (be-)handlungsleitenden Orientierungsrahmen der beteiligten Akteure, wie z. B. deren Annahmen zur Veränderbarkeit arbeitsbezogener Risikofaktoren. Die größte Stärke des individuumsbezogenen Ansatzes liegt in der Stärkung der Selbstsorge, seine größte Begrenzung im einseitigen Fokus auf die individuelle (An-)Passung und der damit einhergehenden Gefahr der Individualisierung von Erkrankung, Ursachen und Bewältigung. Der systemische Ansatz verspricht Nachhaltigkeit durch die Kombination individuumsbezogener und betrieblicher Maßnahmen. Die Herausforderung hier besteht darin, die richtige Balance zwischen individueller Selbst- und betrieblicher Fürsorge zu finden.Die Ergebnisse zeigen, wie psychisch erkrankte Beschäftigte mittels vernetzter und arbeitsplatzbezogener Angebote bei ihrer Wiedereingliederung unterstützt werden können. Sie zeigen jedoch auch, an welche Grenzen bisherige Ansätze stoßen und geben damit wichtige Hinweise für deren Weiterentwicklung und Dissemination.

The aim of the study was to assess insurants' views on various forms of medical rehabilitation of the German Federal Pension Insurance (DRV).In ten focus groups, participants (n=78, 65% female, M=52.2 years) discussed the advantages and disadvantages of inpatient rehabilitation, outpatient rehabilitation, rehabilitation parallel to work, and case management. Central to discussion were treatment modalities such as setting, duration and cooperation with other actors in the health care system. The focus groups were transcribed and analyzed qualitatively (Mayring, 2008).Many participants expressed the need to be removed from their daily routine in order to concentrate on rehabilitative treatment. The perceived lower treatment intensity and double pressure of outpatient rehabilitation are feared to have a negative effect on treatment outcome. According to participants, the fit between the rehabilitation form and the needs of the rehabilitant is crucial.The qualitative data can be used to adjust rehabilitation treatment to insurants' needs.Ziel war es, Sichtweisen von Versicherten der DRV Bund zu verschiedenen Formen der medizinischen Rehabilitation zu erheben.In 10 Fokusgruppen diskutierten die Teilnehmer (n = 78, 65% weiblich, M= 52,2 Jahre) die Vor- und Nachteile verschiedener Formen der medizinischen Rehabilitation (stationär, ambulant, berufsbegleitend, Fallmanagement). Im Mittelpunkt standen organisatorische Rahmenbedingungen (Wohnortnähe, Zeitrahmen, Vernetzung mit anderen Akteuren). Die Transkripte wurden zusammen mit einer ergänzenden Online-Befragung qualitativ ausgewertet (Mayring, 2008).Die Herauslösung aus dem Alltag ist für viele Teilnehmer Voraussetzung, um sich auf eine Rehabilitation konzentrieren zu können. Bei der ambulanten Rehabilitation könnten sich die wahrgenommene geringere Betreuungsintensität und Mehrfachbelastung negativ auswirken. Die Passung zwischen Reha-Form und den Bedürfnissen des Rehabilitanden ist laut der Befragten entscheidend.Die qualitative Bewertung aus Versichertenperspektive kann genutzt werden, um die Gestaltung von Reha-Angeboten der DRV stärker an den Bedürfnissen der Versicherten auszurichten.

In light of the current humanitarian crises in the Arabic world, a version of the Mini International Neuropsychiatric Interview (MINI) in standard Arabic, enabling a fast and efficient diagnosis of psychiatric disorders, is urgently needed. The aim of the present pilot study was to provide a culturally sensitive translation and adaptation of the MINI to standard Arabic and to undertake first steps towards its validation in a sample of Arab refugees.Various experts in the field of psychiatry and psychotherapy, familiar with both Western and Arab cultures, were involved in the multi-level adaption process. N = 20 Arabic speaking refugee patients could be recruited for the pilot study at the Clearingstelle, established by the Charité, Univeritätsmedizin Berlin. The MINI diagnoses were compared to diagnoses by experts who were blinded to the MINI diagnoses, and screening instruments for depression (Patient Health Questionnaire 9, PHQ-9) and posttraumatic stress disorder (PTSD) (Harvard Trauma Questionnaire, HTQ) were used.Details concerning the particularities of the cultural adaptation process are comprehensively summarized and presented. Kappa values did not show any satisfactory concordance between the MINI and expert diagnoses. However, significantly strong concordance was found between the MINI and the PHQ-9 (κ = .69) and the HTQ (κ = .68).These results provide first indications for the validity of the standard Arabic version of the MINI and can be used as a basis for further, more comprehensive validation studies. Moreover, this study depicts a model process for the cultural adaptation of psychometric instruments.Trotz des erheblichen Bedarfs nach einer schnellen und effizienten Diagnostik aufgrund von aktuellen humanitären Krisen in der arabischen Welt, steht bisher keine validierte, hocharabische Version des Mini International Neuropsychiatric Interview (MINI) für die Versorgungsforschung zur Verfügung. Das Ziel der vorliegenden Pilotstudie war es daher, eine Übersetzung und kultursensible Adaptation des MINI ins Hocharabische zur Verfügung zu stellen sowie erste Validierungsversuche in einer arabischsprachigen Geflüchtetenstichprobe vorzunehmen.An dem mehrstufigen Adaptationsprozess waren mehrere psychiatrisch-psychotherapeutische ExpertInnen beteiligt, die sowohl mit der westlichen als auch der arabischen Kultur vertraut sind. N = 20 arabischsprachige geflüchtete PatientInnen nahmen an der Pilotstudie teil, die an der Clearingstelle der Charité, Universitätsmedizin Berlin rekrutiert werden konnten. Für die Feststellung der Kriteriumsvalidität wurden Diagnosen von ExpertInnen, die gegenüber den MINI Diagnosen ‚verblindet’ waren und Screeninginstrumente für Depression (Patient Health Questionnaire 9, PHQ-9) und die posttraumatische Belastungsstörung (PTBS) (Harvard Trauma Questionnaire, HTQ) herangezogen.Aufgrund der ausführlichen Dokumentation kann der Prozess der kulturellen Adaptation detailliert nachvollzogen werden. Kappa Werte zeigten keine Übereinstimmung der MINI Diagnosen mit den ExpertInnendiagnosen, jedoch konnten hohe Übereinstimmungen zwischen den MINI Diagnosen und dem PHQ-9 (κ = .69) und dem HTQ (κ = .68) festgestellt werden.Die Ergebnisse der Pilotstudie werden als erste Hinweise für die Validität der hocharabischen Übersetzung des MINI gewertet und bilden die Grundlage für weitere, ausführliche Validierungsstudien. Darüber hinaus zeigt diese Studie einen Modellprozess für die kulturelle Adaptation psychometrischer Instrumente auf.

Zusammenfassung

Zusammenfassung

This study examines the perspectives of patients and family caregivers on outpatient palliative care networks. It contrasts primary palliative care (AAPV) and specialized outpatient care (SAPV) services, particularly in regard to pain management.The study is based on 27 semi-structured, problem-focussed interviews with 21 patients and 19 informal caregivers. Recruitment was based on purposive sampling in two regions of Brandenburg, Germany. The data were analysed using qualitative content analysis.In AAPV, the general practitioner (GP) is both the central point of contact as well as the coordinator of the care network. In SAPV, the GP plays a less important role. This can lead to conflicts between GPs and health care professionals of the palliative care team. Compared to AAPV, palliative care teams are attributed greater intervention capacities in acute situations as well as expertise in pain therapy. Thus, the option of parenteral administration of opioids is considered a benefit of specialized care. The use of nursing services varies considerably depending on the individual care network-in some cases care is completely taken over by relatives. Relatives are the closest to the patient within the care network and perform key tasks.The personal and professional composition of networks of outpatient palliative care varies individually according to care situation and form. Care networks of AAPV and SAPV differ with regard to the accessibility of health care professionals and pain therapy. Home-based palliative care is often made possible by informal care givers in the first place.

Caregiving from a distance is understudied as well as rarely sociopolitically debated in Germany. Accordingly, distance caregiving is a type of informal care work that has been little acknowledged in social law.This article addresses the issue of how aware sociopolitical experts in Germany are of distance caregiving. Moreover, it points out the challenges the experts perceive in the legal framework and which solutions they can identify.Guided interviews were conducted with six experts from sociopolitical areas in Germany with points of connection to care politics (ministries, associations, organizations). The interviews were analyzed based on the method of summarizing qualitative content analysis (according to Mayring).Even though distance caregiving has played a minor role among the sociopolitical experts, they were aware of individual aspects of this topic, mostly based on having been personally affected. Due to this experience they argued for a broader understanding of care including for example organizational support. They criticized the lack of sociopolitical consideration of distance caregivers and among other things demanded a functioning local support system.The interviews indicated a specific and personal awareness of distance caregiving; however, the findings pointed to stronger criticism of the overall situation regarding caregiving relatives. Thus, despite all recent reforms in distance caregiving there is still a need for action on the topic of caregiving relatives.

Family caregivers are important players in both inpatient and domestic healthcare. As a result of increasing mobility many also perform care over geographical distances.The article highlights the opportunities and challenges of distance caregiving from a distance caregivers' perspective. Data were collected as part of the binational research and development project on distance caregiving, which investigated various dimensions of distance caregiving with an interdisciplinary team from Germany (Protestant University Ludwigsburg) and Switzerland (Careum University of Applied Sciences Zurich). To date empirical results exist mainly for the Anglo-American region. This study provides hitherto lacking empirical findings for Germany and Switzerland.The study was based on 49 guideline-based, partially narrative interviews (Germany: N = 35; Switzerland: N = 14) with distance caregivers, who at the time of data collection were caring for a person at least 60 years old. The software-supported data analysis (MAXQDA 10) was carried out using deductive and inductive structuring content analysis according to Mayring.Distance caregivers provide substantial and diverse care and support tasks. A central challenge is the lack of up to date and reliable information regarding the care situation. This may lead to emotional strain; however, distance also results in relief for caregivers. A functioning network including well-defined agreements and transparent communication is crucial.

Numerous studies have shown that psoriasis is associated with severe losses in almost all dimensions of health-related quality of life. An important aspect is the stigmatization experience of those affected.The aim of this study was to examine the perception of stigmatization from the perspective of patients, relatives and healthcare professionals using a qualitative approach.Qualitative surveys in the form or focus groups and interviews with patients, relatives and healthcare providers were conducted. The data were analyzed by qualitative content analysis.The results show that stigmatization is perceived by all groups surveyed. It also became clear that self-stigmatization plays a special role. Affected persons, relatives and medical care providers described self-stigmatization as the greatest burden or restriction of affected persons in various areas of life, such as work, leisure and partnership. There were no crucial differences between sex or age groups.Possible knowledge deficits of non-affected persons and wrong assumptions of the affected persons about the attitudes of non-affected persons can be reduced, for example, in the context of encounters between affected persons and non-affected persons as well as between affected persons and medical care providers and thus reduce the public as well as the self-stigma.

A relevant number of older persons with intellectual disability (ID) moves from residential settings in the disability sector to nursing homes. The study analyzes from the perspective of self-determination, which factors lead to moves to nursing homes and to what extent older persons with ID and their relatives participate in decision-making.Quantitative telephone interviews and surveys were conducted in general and specialized nursing homes in Westphalia-Lippe. In three specialized nursing homes, qualitative interviews focused on relocation decisions from different perspectives.Decisions to move were induced on one hand by the insufficient fit and adaptation of the support to the needs of older residents in settings of the disability sector. On the other hand, organizational interests of the nursing homes influenced the decisions. The counselling of residents and their relatives and the participation in decision making were inadequate.Efforts should be taken to strengthen self-determined relocation decisions of older persons with ID. The specific function of specialized nursing homes for aged persons with ID has to be clarified.

Shared decision-making (SDM) is becoming increasingly important in medical care. The relevance of SDM after diagnosis is especially noticeable in the care of prostate cancer patients, since affected patients can choose from different treatment strategies.What are the experiences of patients regarding SDM in the treatment of prostate cancer?Interviews with qualitative-exploratory study design were carried out and evaluated. The interviews were recorded with the help of audio tapes and literally transcribed and pseudonymized based on Kuckartz. The evaluation was done by theoretical coding according to Glaser and Strauss. This enabled the development of an object-based theory of interview data.The study shows that all interviewees experienced SDM and were able to reflect on this process. The interviewed patients had a high level of information regarding their disease status and treatment options, in which individual preferences played a key role. Some patients saw potential for optimization in the physician-patient conversation, taking personal preferences into account.Patients are not limited to medical information only, but have taken an active role in their treatment decision. Many of the participants consulted several physicians to obtain second opinions. Since the survey focuses on the patients' perspective, it remains unclear whether a joint exchange of information and decision-making has taken place from a medical point of view.

It is regularly criticized that the detection of dementia in primary care is not effective enough, especially with regard to early stages of dementia. Previous research results suggest that there are reservations among general practitioners towards dementia diagnostics. So far, however, the causes for this or the positions and strategies of general practitioners towards dementia care have not been sufficiently investigated. The aim of the study was to investigate the attitudes of general practitioners towards dementia diagnostics, to identify common challenges in day-to-day practice and to derive starting points for optimization.In the course of a survey, which was developed on the basis of a separate preliminary interview study, 425 general practitioners in Rhineland-Palatinate were interviewed (survey period: November 2017 - January 2018).The results show that a considerable part of the doctors surveyed have withdrawn from dementia diagnostics and delegated the care of dementia patients exclusively to the medical specialist level. From the data material, various reservations and challenges can be summarized, which can be seen as barriers to the effectiveness of primary care for dementia patients: 1) Low self-efficacy perception towards dementia, 2) differential diagnosis as hurdle, 3) challenges in doctor-patient communication, 4) lack of remuneration, 5) low involvement of practice staff members, 6) more negative attitudes towards dementia diagnosis due to lack of geriatric education, 7) limited cooperation with and knowledge of regional counseling and care services.Several starting points can be identified to further optimize the GP dementia diagnoses and care: 1) Increased awareness of options beyond therapeutic interventions, 2) differential diagnosis and care pathways, 3) doctor-patient communication, 4) remuneration and incentives, 5) involvement of practice staff members, 6) higher sensitivity due to geriatric education, 7) cooperation with and knowledge of dementia care and counseling services.Regelmäßig wird moniert, dass die Erkennung von Demenzerkrankungen in der hausärztlichen Versorgung nicht effektiv genug sei, besonders mit Blick auf frühe Demenzstadien. Studien lassen vermuten, dass unter Allgemeinmedizinern diverse Vorbehalte hinsichtlich der Demenzdiagnostik bestehen. Welche Ursachen diese haben und welche konkreten Positionen sowie Strategien Hausärzte bei der Versorgung von Demenzpatienten vertreten, wurde bislang kaum untersucht. Ziel der Studie war es, Einstellungen von Hausärzten in Bezug auf die Demenzdiagnostik genauer zu beleuchten, verbreitete Herausforderungen im Praxisalltag herauszuarbeiten sowie Ansatzpunkte für eine Optimierung abzuleiten.Mittels schriftlicher Befragung, die auf Basis einer separaten Interview-Vorstudie fundiert, wurden zwischen November 2017 und Januar 2018 insgesamt 425 Hausärzte in Rheinland-Pfalz befragt.Ein beträchtlicher Teil der befragten Hausärzte hat sich aus der Demenzdiagnostik zurückgezogen und delegiert die Betreuung von Demenzpatienten ausschließlich an die Facharztebene. Aus den Ergebnissen lassen sich verschiedene Vorbehalte und Herausforderungen verdichten, die der Effektivität der hausärztlichen Demenzversorgung entgegenwirken: 1) geringe subjektive Wirksamkeitswahrnehmung beim Krankheitsbild Demenz, 2) differenzialdiagnostische Abklärung als Hürde, 3) Schwierigkeiten bei der Arzt-Patient-Kommunikation, 4) mangelnde Honorierung, 5) geringe Einbeziehung des Praxispersonals, 6) negativere Einstellungen zur Demenzdiagnostik durch Fehlen geriatrischer Weiterbildung, 7) begrenzte Zusammenarbeit mit und Kenntnis von regionalen Beratungs- und Versorgungsangeboten.Aus der Analyse gehen mehrere Ansatzpunkte hervor, auf deren Basis sich die hausarztbasierte Demenzversorgung weiter verbessern ließe. Hierbei handelt es sich um 1) verstärktes Bewusstsein für Handlungsoptionen jenseits therapeutischer Interventionen, 2) Differenzialdiagnostik und Behandlungspfade, 3) Arzt-Patient-Kommunikation sowie 4) Honorierung und Anreize, 5) Involvierung des Praxispersonals, 6) höhere Sensitivität durch geriatrische Weiterbildung, 7) Kooperation mit Beratungs- und Versorgungsnetzwerken.

Current studies on breastfeeding behavior that adequately consider migration aspects are not available from Germany. The following research questions should be answered with the help of a prospective study: What factors influence the probability of (premature) weaning and actual breastfeeding duration? What roles do migration background (MB) and generation play? Do observed effects persist after controlling for education, parity, etc.?In a one-year study in 3 Berlin maternity hospitals, women were interviewed on socio-demografic details and migration aspects on admission to the delivery room. On the 2The pre-partum group included 7,100 women (57.9% with a migrant background), 6,884 women were interviewed on the maternity ward, and 605 women were in the sub-cohort questioned six months postpartum. 55.9% of first-generation migrant women, 32.9% of 2The migration background factor has only a small influence on breastfeeding behavior. Possible differences should take the migration generation into account.Aktuelle Untersuchungen zum Stillverhalten mit einer angemessenen Berücksichtigung von Migrationsaspekten liegen aus Deutschland nicht vor. Folgende Forschungsfragen sollten mithilfe einer prospektiven Studie beantwortet werden: Welche Faktoren beeinflussen (vorzeitige) Abstillwahrscheinlichkeit und tatsächliche Stilldauer? Welche Rollen spielen Migrationshintergrund (MH) und -generation? Bleiben beobachtete Effekte bestehen, wenn für Bildung, Parität usw. kontrolliert wird?In einem einjährigen Untersuchungszeitraum wurden in drei Berliner Geburtskliniken Frauen bei Kreißsaalaufnahme u. a. zu soziodemografischen Angaben und Migrationsaspekten befragt. Am 2./3 Tag post partum erfolgte nochmals ein standardisiertes Interview u. a. zu Stillbeginn und geplanter Stilldauer. Ein Teilkollektiv wurde 6 Monate post partum telefonisch u. a. zur tatsächlichen Stilldauer befragt. Das Stillverhalten wurde anhand multivariater Regressionsmodelle analysiert. Für die Analyse der tatsächlichen Stilldauer und möglicher Einflussfaktoren wurde eine Cox-Regression durchgeführt.Das präpartal befragte Kollektiv umfasste 7100 Frauen (57,9% mit Migrationshintergrund), auf den Wochenbettstationen wurden 6884 Frauen erreicht, beim Teilkollektiv 6 Monate postpartal 605 Frauen. 55,9% der Migrantinnen der 1. Migrantinnengeneration, 32,9% der Frauen der 2./3. Generation und 52,9% der Frauen ohne MH stillten 6 Monate postpartal noch (p0,001). Im adjustierten Regressionsmodell hatten Frauen mit Migrationshintergrund eine größere Chance mit dem Stillen zu beginnen als Frauen ohne MH. Mit einer Regressionsanalyse nach Cox wurde die Wahrscheinlichkeit, innerhalb von sechs Monaten abzustillen, überprüft: Im adjustierten Modell zeigte sich kein Effekt des Migrationsstatus.Der Faktor Migrationshintergrundes hat nur einen geringen Einfluss auf das Stillverhalten. Bei der Betrachtung möglicher Unterschiede sollte die Migrationsgeneration beachtet werden.

Using qualitative-hermeneutical methods with a focus on biographical (risk-) constellations for conditions of success or failure of return to work - and therefore on the efficiency and sustainability of employment participation benefits - the study accompanies participants during a time span of 2 years after their vocational retraining on their way back into the first labor market.The study applies a mixed method design which combines 30 episodical-narrative interviews of participating rehabilitants alongside with a questionnaire survey of a total of 214 participants and 19 interviews of scientists and vocational retraining experts.Overall approximately 80% of the participants of our sample successfully return to work within a period of 18 months. Significant barriers can be illustrated by characteristic risk constellations, which correspond to the following dimensions: occupational choice, coping with illness, the need for protective area beyond the rehabilitation scheme, lack of (typical) life course orientation, lack of acceptance of a transitional phase with lower salary, regional occupation-specific labor market as well as social inclusion and support.Qualitative-hermeneutical methods generate - apart from diagnostic attributions and theoretical hypotheses - new factors effective for return to work with importance for rehabilitants; these factors refer to their embeddedness in processes, interrelations and interactions between biography, context factors, and administrative routines. The results identify specific needs for post-rehabilitation services supporting persons with risk constellations.Mit dem Blick auf biografische (Risiko-)Konstellationen für Ge- und Misslingensbedingungen – und damit auf die Wirksamkeit und Nachhaltigkeit von Leistungen zur Teilhabe am Arbeitsleben – begleitet die Studie mit qualitativ-hermeneutischen Verfahren berufliche Rehabilitandinnen und Rehabilitanden über einen Zeitraum von etwa 2 Jahren nach der Umschulung auf dem Weg zurück ins Beschäftigungssystem.Die Studie folgt einem Mixed-Method-Design. Neben einer Fragebogenerhebung von insgesamt 214 Teilnehmern und 19 Interviews mit Experten aus Wissenschaft und Praxis bilden 30 episodisch-narrative Interviews mit teilnehmenden Rehabilitanden den Schwerpunkt des Forschungsdesigns.Insgesamt gelingt etwa 80% der Maßnahmenteilnehmer unseres Samples nach 18 Monaten der Übergang in Erwerbsarbeit. Entscheidende Hemmnisse für das Gelingen zeigen sich in charakteristischen Risikokonstellationen, die durch Umschulungsberufswahl, Umgang mit der Krankheit, Schonraumbedarf, Lebenslauforientierung, Zielorientierung, Akzeptanz einer Übergangsphase mit geringerer Entlohnung, regionaler berufsspezifischer Arbeitsmarkt sowie soziale Einbindung und Unterstützung gekennzeichnet sind.Mithilfe qualitativ-hermeneutischer Verfahren wird es möglich über Diagnose(-zuschreibung) und andere aus der Theorie bekannte Aspekte hinausgehend, neue, für die Rehabilitanden wichtige Wirkfaktoren zum Return to Work zu generieren. Diese verweisen auf deren Einbettung in Prozesse, Kontexte, Zusammenhänge und Wechselwirkungen zwischen Biografie und Kontextfaktoren. Aus den Ergebnissen lassen sich konkrete Unterstützungsbedarfe und Handlungsansätze für kritische Risikokonstellationen entwickeln.

The aim of this pilot study was to estimate the share of working time that staff in psychiatric hospitals theoretically spend on obligatory activities, such as training and further education, organizational and documentation tasks as well as statutory lecturing duties without patient contact. A total of 47 physicians, 39 nurses, 34 psychologists and 35 social workers from eight psychiatric hospitals were interviewed. The results reveal that the theoretically remaining time for direct patient contact is low. The ratio of time spent with versus time spent without patient contact was even worse for senior physicians and leading nurses as well as part-time employees; however, all activities without direct contact to patients seemed to be indispensable in terms of quality of treatment and care. Hence, employees in German psychiatric hospitals regularly have to make decisions on which of their duties they prefer to neglect, to which they are actually obligated.

Low-threshold consulting services are becoming increasingly more important as an addition to outpatient and inpatient services.What quality criteria do providers of low-threshold consulting services for family caregivers of people with dementia have?Telephone interviews with 36 providers of family counseling, support groups, care course. Qualitative content analysis according to Mayring complemented by a literature search.The quality criteria of the providers are based on frequent, ongoing, daily life-oriented, family-oriented, relief-providing, professional, and cross-linked services.Increased cooperation and coordination of all involved stakeholders is necessary to improve the knowledge and utilization of the services and the qualitative orientation.

A multitude of studies have demonstrated a positive effect of spirituality for dealing with difficult situations in life; however, specific studies on spirituality in older age are exceptionally rare within the German gerontological research landscape. The theory of gerotranscendence by Tornstam indicates that spirituality is of particular importance for maintaining life satisfaction especially in older age, due to a change in perspective.This study looked into the research questions of how spirituality is presented in the oldest old (80 years and older) in Germany and to what extent its characteristics are specific to older age.Problem-centered interviews were conducted with 20 oldest old subjects and evaluated using qualitative content analysis.Spirituality in itself is not specific to very old age. Its shaping, however, as an existential process of transformation and redefinition, is specific in the oldest old due to their socialization and biographical experiences over the life course impregnated by processes of subjectification and individualization. In addition, its relation to existential questions gains increasing relevance and priority in very old age in an affective, reflective and performative dimension, and the answers change between fragility and continuity.As a heterogeneous (intermediate) result of experiences over the life course against the background of socialization and individual existential interpretation of "Self" and "World", spirituality in the oldest old should be perceived in this diverse and dynamic manner in research and practice, in order to foster well-being in old age.

Family members undertake a large proportion of the care of people living with dementia. The purpose of this study was to explore the needs and caring experiences of family caregivers of people with dementia in Austria, who were organized in a self-help group.Using an explorative, qualitative research design, data were collected through 1 focus group and 3 in-depth interviews with a total of 10 family caregivers of people with dementia from a self-help group. An inductive qualitative analysis was applied and resulted in four themes: frightening images of dementia in society, continuity and conflicts in the relationship to the person with dementia, caring for one's own health and lack of support and community.Continuity in the relationship to and joint activities with the person with dementia were positively described but simultaneously the frequently occurring conflicts were described as burdensome. Also described were bureaucratic, structural and financial hurdles for the utilization of support services. The existing support systems offered were mostly judged to be inadequate, inaccessible or unaffordable. The participating caregivers described the communication of the diagnosis of dementia in the environment as a prerequisite for support in the community.Destigmatization and the further development of dementia-specific support offers and self-help groups for caring relatives and people living with dementia could represent further steps forward. Communicating the dementia diagnosis in the social environment and community seems to be an important but difficult step for caregivers organized in a self-help group.

Traditional municipal services are not successful at reaching Turkish seniors. Compared to native Germans Turkish seniors have a lower social participation.Do native language groups hosted by a German organization promote the social participation of Turkish seniors? How does social participation take place in the ZWAR networks (between work and retirement; a project to strengthen social participation of seniors) and which factors promote or reduce social participation?Qualitative structuring content analysis of two group discussions, which were based on guided interviews.The social participation of Turkish-speaking seniors was strengthened on three levels: (1) through regular meetings of the Turkish ethnic group social relationships were promoted and German language skills and other skills were improved. Through mutual sharing and understanding of the stressors specific to migration, emotional support was provided. The sharing of mutual cultural and linguistic backgrounds created a sense of community and meetings were perceived as an antidote to migrants' exhausting lives in German society. (2) At the organizational level, participation was promoted through extensive group events. Regardless of their cultural background all participants identified as equal ZWAR members. The ZWAR project functioned as an umbrella organization for participation in the intercultural context. (3) Participation in community events created contacts with community stakeholders and fostered volunteer work. Hence, participants were able to use their skills, and therefore broaden their horizons.Turkish ZWAR networks promoted the social participation of members because integration with their ethnic group reduced access barriers, broadened members' scopes of action, and created new opportunities for participation.

Communicating and interacting with persons diagnosed with dementia (PwD) present a challenge to pastoral carers, since most classical pastoral care approaches concentrate on conversation as a medium of relationship formation and do not take limited communication skills into account. This study focuses on the following question: how can hospital-based pastoral carers find appropriate methods of communication and interaction with PwD and provide them with pastoral care?A total of 10 professional pastoral carers participated in the study. Each of these persons had extensive experience with PwD. Data were collected with the use of guideline-based interviews. The interviews were evaluated using Mayring's method of qualitative content analysis.One of the main challenges faced by the pastoral carers in interacting with PwD was to explore communication strategies based on non-verbal communication, in addition to verbal communication. Pastoral carers need to find alternative communicative approaches, such as biographical, non-verbal, and physical sense-related methods. Clinical pastoral education did not adequately equip these professionals for communicating and interacting with PwD. The interviewed pastoral carers acquired this specific knowledge through independent research of the academic literature, observation of other professionals, dementia-specific training courses, and practical experience.Pastoral carers can make a positive contribution to the holistic care of PwD through their unique communicative and relationship approach to care. It is imperative to develop adequate pastoral care concepts and to integrate methodologies for dealing with PwD into the training curriculum of pastoral carers.

We evaluated the qualitative and quantitative changes of medications during the stay on a geriatric-psychiatric ward where the medication was optimized by a clinical pharmacist, and after discharge. The goal of the study was to analyze the continuity of the medication at the transfer from hospital to ambulatory care.We interviewed 41 patients on the phone about their drug regimen 4 and 12 weeks after discharge. Medications were compared to their discharge medication. The number of medications from the PRISCUS list of inappropriate medications for the elderly as well as the number of drug interactions was documented. The drug interaction database MediQ was used to identify and classify the drug-drug interactions.During the hospitalization of the patients, 101 interventions of the clinical pharmacist were recommended and accepted. In cooperation with the physicians, the number of drug interactions decreased by 44% and the number of PRISCUS list medications by 42%. Only 4 weeks after discharge, 54 drugs for 27 patients (66%) had already been changed. During the following 8 weeks, another 44 medications were changed in 14 patients (35%). The total number of drugs after discharge did not change. The number of moderate drug interactions (p = 0.17) of medications from the PRISCUS list increased (p = 0.77), but not significantly.While the interventions of a clinical pharmacist can lead to a reduction in drug interactions and inappropriate medication for the elderly during the hospitalization, the medication was changed after discharge in numerous cases. In a detailed analysis it was found that some of the changes increased the number of drug interactions as well as the number of potentially inappropriate medications for the elderly. A drug interaction check after discharge could prevent drug interactions and medication errors. Also the nationwide medication plan can help to prevent medication errors by the prescribing physician as well as by the patient.

The perception of patients' needs of support and sensitive communication about psychosocial stress all represent new, exacting tasks for nursing staff, midwives, social workers and physicians in obstetrics. As part of Good Start into the Family (GuStaF), a learning and teaching project in a university hospital, we were able to interview parents about their experiences with the intervention.Evaluation of the process of establishing contacts, the communication with professionals in obstetrics and the support offered from the perspective of parents.Qualitative guided interviews with seven families one year after the delivery.Problem areas reported by parents were predominately related to increased parental care and the feeling of being overwhelmed in addition to social stress. Core themes in communication addressed the entry into conversations, which was remembered negatively when advice was perceived as improper, patronizing or stigmatizing, and positively when professionals had listened sensitively and had provided tangible support. Some conversations increased stress. Relating to assistance and support, parents reported both positive and negative experiences. Justness and reliability emerged as particularly important topics.The attendance of families around the time of the delivery poses varying demands upon the hospital staff, not necessarily in keeping with traditional professional attitudes and competencies. Careful attention to the personal physical and emotional well-being of mothers and newborns, non-stigmatizing entry into the conversations, justness of the support and avoiding inconsistencies within the institution and the network all appear to be of great importance.

The population of centenarians has grown immensely in Germany but has yet hardly been considered in research on dying and death. Due to their very old age centenarians are especially intensively confronted with the challenge of the end of life.The aim of this study was to analyze how centenarians handle the existential challenge of the end of life and which aspects are especially significant for them. Conclusions drawn from this analysis were used to identify factors to improve the needs-based provision of care.Trained interviewers interrogated 15 centenarians living in Berlin using semi-structured interviews based on theoretically developed and tested guidelines. Subsequently, the interviews were transcribed, computer coded and analyzed following the method of the qualitative content analysis according to Kuckartz.In the categories "experience with dying and death" and "preparing for the end of life" it was shown to be significant that respondents often referred to the dying of others with respect to their worries and wishes at the end of their life. Additionally, the subcategories "putting things in order", "settling provision of care" and "having conversations" were shown to be highly relevant for the participants in the study.Decisions related to care in the process of dying, for example by advance directives, arrangements for inheritance and funeral as well as communication about dying and death, are central needs of centenarians when preparing for the end of life. There is sometimes considerable need for professional support and protection.

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The attitude as well as the expertise of a person affect the behavior and actions in daily life. To investigate the influence of attitude and knowledge of pig producers on the use of antibiotics in farms, 220 Swiss pig producers were questioned on health awareness, attitude towards sustainable production, risk behavior, intrinsic motivation and knowledge about antibiotics and resistance development. In addition, the strategy of antibiotic use (therapeutic or prophylactic) and the business practice (single or group therapy) for the amount of antibiotics on one hand and for the risk of antibiotic resistance development on the other hand, were determined in a personal interview. Farmers using antibiotics only therapeutically had a better business practice. A direct link between the personal attitude and the antibiotic use or a higher risk of development of antibiotic resistance was not found in this investigation.

Supplementary pain-related recommendations for the treatment of chronic pain in children and adolescents are an essential component of multimodal pain treatment. Studies are scarce regarding adherence to these recommendations and their effectiveness.The aim of this study was to evaluate patient adherence to pain-related recommendations and their effectiveness 12 months after initial presentation of children and adolescents with chronic pain to a pediatric outpatient pain clinic.A total of 413 patients were assessed using a structured telephone interview. The assessment included pain characteristics during the last 4 weeks as well as information regarding the implementation of the pain-related recommendations and the effectiveness. Due to different recommendations given to migraine patients this subgroup was dealt with separately.Patients reported significant improvements 12 months after the initial presentation and 29.5 % of the patients were pain free. Adherence levels and estimated effectiveness regarding recommendations, such as change of lifestyle, multimodal inpatient treatment and use of medication were high. Other recommendations, such as active relaxation and outpatient psychotherapy had low adherence levels and low estimated effectiveness. Migraine patients had a significantly higher adherence rate and estimated effectiveness regarding the recommendation use of medication than non-migraine patients.The adherence level as well as the estimated effectiveness regarding the majority of pain-related recommendations was high. Some recommendations had low adherence rates and low estimated effectiveness. These results can help to further improve the performance of outpatient clinics for children and adolescents with chronic pain.

Similarities and differences of integration of palliative care in clinical care, research and education structures at German Comprehensive Cancer Centers (CCC) are not known in detail.Provide an overview of availability and the way of integration of specialized palliative care at CCCs funded by the German Cancer Aid (Deutsche Krebshilfe, DKH).We conducted structured interviews from May to August 2014 with heads of palliative care departments (personally or by telephone). The interviews included a quantitative and a qualitative part. Other stakeholders of CCCs were asked the questions of the qualitative part. We evaluated the qualitative data using the content analysis by Mayring and MAXQDA 11.0. SPSS 21.0 was used for quantitative analysis.26 interviews were realized in 13 CCCs with 14 sites, which received funding, by DKH till August 2014 (one CCC had two university hospitals). Of these, 12 sites had a palliative care unit (86%), 11 sites had palliative care consulting services available (79%). Participation of palliative care specialists in tumor boards is not provided in 3 institutions (21%) and is often not feasible on regular basis in the other institutions, due to staffing shortage. In 7 sites (50%) defined criteria to integrate palliative care into CCCs were available. In the last 5 years specialized palliative care of 4 sites received an invitation for a research project by another department within the CCC (29%). 10 sites (71%) had started own palliative care research projects. Chairs in palliative care were available in 4 CCCs (29%).The extent and depth of palliative care integration in the 14 CCC sites is heterogeneous.

Diese Arbeit beschäftigt sich mit der Informationslage, dem vorhandenen Ausmaß an Unterstützung sowie der Einstellung und dem Interesse an der Forschung von jungen Erwachsenen aus Huntington-Familien. Dabei wurde das Vorhandensein von Informationen und Unterstützung von den Teilnehmern beurteilt und die empfundene Wichtigkeit bestimmter Fragestellungen ermittelt. Als Zielsetzung sollte erstmals ein Überblick der Situation junger Erwachsener aus Huntington-Familien geschaffen werden und aus den Ergebnissen abgeleitet, das Behandlungs- und Beratungsangebot entsprechend den neuen Erkenntnissen optimiert werden. Die Befragung erfolgte mit insgesamt 463 Teilnehmern aus 31 Ländern anhand eines strukturierten Fragebogens, welcher in 10 Sprachen zur Verfügung stand und eine Teilnahme sowohl in Papierform, wie auch online ermöglichte. Die Zielgruppe umfasste junge Erwachsene aus Huntington-Familien, die Risikopersonen, Personen mit einem negativen Gentest oder bis dato symptomlose Mutationsträger sein konnten. Die Ergebnisse zeigten das auffallend größte Informationsdefizit in der Rechtsberatung, gefolgt von den empfohlenen Lebensgewohnheiten und der Situation nach dem Gentest. Die beste Informationslage bestand hingegen bei der Aufklärung über die Huntington-Erkrankung selbst, gefolgt von Informationen zum Gentest, der Situation als Risikoperson und dem Thema Kinderwunsch. Zu anderen familiären Fragestellungen, wie Aufklärung der Kinder über die Erkrankung, Umgang mit Angehörigen, Aufwachsen in einer Huntington-Familie, Beziehungen und Freundschaft, war die Informationslage hingegen weniger gut. Die Unterstützung durch Gleichbetroffene und durch das Internet wurde in ihrer Wichtigkeit und ihrem Ausmaß an Unterstützung annähernd identisch beurteilt. Bei beiden Unterstützungsarten erhielt rund ein Drittel der Befragten keine und ebenfalls je ein Drittel nicht genug Unterstützung. Der größte Mangel erwies sich bei der professionellen Unterstützung, wobei trotz hoher empfundener Wichtigkeit ein großer Teil der Befragten keine professionelle Unterstützung erhielt, sei es durch Psychologen, Humangenetiker oder in einer Huntington-Sprechstunde. Mangelnde Unterstützung ließ sich auch beim Treffen wichtiger Entscheidungen und der Behandlung von Beschwerden ermitteln. Die Befragten zeigten großes Interesse an der Forschung, den Wunsch, mehr darüber zu erfahren und selbst daran teilzunehmen. Der Mehrheit war allerdings nicht bekannt, wie eine eigene Beteiligung möglich ist und nur wenige der Befragten nahmen bisher an der Forschung teil. Mutationsträger zeigten die größte Bereitschaft einer eigenen Forschungsbeteiligung und waren auch am meisten bereits daran beteiligt. Risikopersonen stellten sich als die am wenigsten informierte Gruppe mit dem geringsten Interesse an einer Forschungsteilnahme heraus. Ungefähr die Hälfte aller Befragten war bezüglich der Forschung auf dem Laufenden. Zur Verbesserung der Informationslage kann in Zukunft mit der Bereitstellung gezielter Materialien zu den ermittelten Wissenslücken und Kontaktdaten zu passenden Ansprechpartnern, wie beispielsweise Versicherungen oder Anwälten zum Thema Rechtsberatung, beigetragen werden. Ebenso sollten der Zugang und das Wissen über die Möglichkeiten der Unterstützung Betroffener verbessert werden sowie an der Optimierung der professionellen Unterstützung gearbeitet werden. Mit Informationen über die Möglichkeiten der eigenen Forschungsbeteiligung und Übersichtstabellen der aktuellen Forschungsstudien kann dem Wunsch nach mehr Einsicht in die Forschung nachgekommen werden. Es ist denkbar, dass eine bessere diesbezügliche Kenntnis eine steigende Forschungsbeteiligung bewirken könnte. Das Internet ist für Betroffene die meist genutzte Informationsquelle bezüglich der Erkrankung, Unterstützung und der Suche nach Forschungserkenntnissen. Mit dem Ausbau bzw. dem Einrichten entsprechender Webseiten kann wesentlich zur Verbesserung der Situation beigetragen werden. Die Ergebnisse der vorliegenden Arbeit können dabei helfen, nach anfänglichen Verbesserungen der Informationsbereitstellung und der Unterstützung im Internet sowie durch Gleichbetroffene, in einem nächsten Schritt Optimierungen der professionellen Unterstützung und der Informationslage über Möglichkeiten eigener Forschungsbeteiligung anzugehen.

The effectiveness of 2 aftercare treatments was examined with regard to patients' implementation of health-enhancing recommendations and changes in psychological distress, as well as mental and physical health.Psychosomatic patients were randomly assigned to an intervention group (aftercare over the telephone or face-to-face) or to a control group without aftercare (n=62) at the end of their treatment. Patients in the intervention group (n=139) were offered up to 4 aftercare conversations during the 3 months after their rehabilitation. Data were collected at admission (t1), at discharge (t2) as well as 3 (t3) and 9 (t4) months after discharge. Patients were asked whether they implemented health-enhancing recommendations, recorded in the discharge report, at t3 and t4. Psychological distress (SCL-90-R) was measured at t1, t2, t3 and t4, mental and physical health (SF-12) at t2, t3 and t4.In the intervention group, more participants implemented the recommendations made at discharge such as sports and exercises or outpatient psychotherapy as compared to the control group. Likewise, participants of the intervention group maintained better their physical health. Aftercare over the telephone and face-to-face did not differ in their effectiveness; however, less time was required for aftercare conversations over the telephone.Aftercare over the telephone seems to be an economical approach to support patients in implementing healthcare recommendations made at discharge after inpatient rehabilitation.

In 2009 palliative medicine was integrated into the undergraduate curriculum as cross-disciplinary subject 13 and is now part of mandatory education in German medical faculties (MF). Surveys across German MFs have shown an inhomogeneous development of this cross-disciplinary subject. The aim of this study was to assess the current state and the needs in terms of assessments in the cross-disciplinary subject 13 at German MFs.Palliative care coordinators at German MFs were surveyed by using a standardized telephone interview. Closed-ended questions were analyzed by descriptive analysis and open-ended questions by content analysis.A total of 34 out of 36 MFs participated. Multiple choice tests were the major form of assessment (94.1%) and 9 MFs planned to implement another form of assessment, mainly an objective structured clinical examination (OSCE) station (55.5%). The majority of the MFs (91.2%) had no blueprint to develop assessments but conducted a review (78.8%) afterwards. A successful implementation of the assessment was mostly achieved when the concept of the assessment was felt to be suitable. The lack of human resources was found to be the most relevant obstacle for the implementation of a practical assessment format.The major form of assessment in palliative care is still a written examination, especially multiple choice tests. This format is considered to be of limited value for assessing communicative competencies and attitudes in palliative medical care. Further steps should include the development of a competence-based assessment that is also feasible for smaller MFs with limited resources.

Frail older people are becoming an increasingly more important target group in healthcare provision. Little is known about patients' views on frailty and its various impacts, especially towards the end of life. This study was carried out to analyze the needs of frail elderly people at the end of life.A qualitative, longitudinal case study design was applied and included 31 frail older patients (≥ 70 year) with a Canadian study of health and aging (CSHA) clinical frailty scale (CFS) grade 6/7 from urban and rural areas within the region of Lower Saxony. The analysis was based on guided interviews and followed the principles of grounded theory.From the patients' perspective frailty is perceived as a process of increasing complexity of health problems, increased vulnerability and reduced ability to perform tasks. Frailty is experienced as various deficits including the physical, psychological, social and existential dimensions. Living and dying in a familiar environment and maintaining autonomy was identified as a core category. Key determinants were access to and quality of healthcare services as well as various individual and social resources.A palliative biopsychosocial care approach should be established early in the process of frailty, including advance care planning in order to meet the patients' needs of staying in a familiar environment. General practitioners as well as home care nursing personnel have to collaborate in order to balance issues of autonomy with increased care needs and the support of informal carers as key partners towards the end of life.

Type 2 diabetes is on the increase among the Swiss immigrants. The cultural background of patients presents new linguistic and sociocultural barriers and gains in importance for health care. In order to develop patient-centred care, it is necessary to focus on different sociocultural aspects in everyday life and experiences of immigrants from the former republics of Yugoslavia with diabetes who have rarely been studied in Switzerland. Based on these insights the needs for counselling can be identified and nursing interventions can be designed accordingly. Using the Grounded Theory approach, 5 interviews were analysed according to the Corbin and Strauss coding paradigm. The central phenomenon found is the experience to live in 2 different cultures. The complexity arises from the tension living in 2 cultural backgrounds at the same time. It turns out that in the country of origin the immigrants adjust their disease management. The changing daily rhythm and the more traditional role model affect aspects of their disease management such as diet and/or drug therapy. The different strategies impact the person's roles, emotions, their everyday lives and their families. It provides an insight into the perspective of Swiss immigrants from the former republics of Yugoslavia suffering from diabetes. Many questions are still unanswered and further research will be required.

Public knowledge about and attitudes towards mental illness were analyzed. Furthermore, changes in knowledge and attitudes after an information and awareness campaign were examined. The basis were two telephone surveys in 2011 (t0) and 2014 (t1) in Hamburg (intervention) and Munich (control). In 2011, the public was relatively well informed about mental disorders. Regarding the level of information of the public before the campaign and inconsistent results of previous evaluation studies the anticipated impact of the awareness campaign at t1 are moderate.

Olfactory dysfunction and loss of smell are mostly associated with an immense decrease in the quality of life. The aim of the presented study was to report on particularities in the acquisition of patients with olfactory dysfunction.During July 2011 and May 2014 we were contacted by 300 potential patients with self-reported loss of smell, 95 (54 female, 41 male, mean age 53) of which were invited for clinical testing after phone interviews.Clinical smell testing revealed 46 patients with anosmia, 38 with hyposmia, and 11 with normosmia. Self-assessment of olfactory function only correlated with clinical scores if patients had nearly no olfactory function left. The ability of self-assessment of olfactory function was independent of age or sex. Further, most patients were not able to report on the reason for or the duration of their olfactory dysfunction.Our report shows that patients with olfactory dysfunction are hardly ever ably to assess their grade of performance reduction. Awareness among patients with a reduced sense of smell is of great general importance, since it can be an indicator of neurodegenerative diseases. This should especially be noted for patients older than 50 who are not able to indicate a reason for their loss of smell.