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Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Background: Students often show unfavourable attribution: they attribute poor school performance to stable factors such as lack of ability and good school performance to variable factors such as effort. However, attribution can be influenced by individualized digital re‐attributional feedback leading to positive motivational effects and higher learning outcomes. This is very promising, but it still is unclear, whether this digital re‐attributional feedback can also be successfully integrated in everyday classroom activities. Objectives: The present field experiment investigated how integrating digital re‐attributional feedback into classroom instruction affects student attribution, motivation and learning outcomes. Methods: In the experiment, 8th–10th grade high school students (N = 322) worked with a digital mathematics learning program which was integrated in a three‐week teaching unit. Half the students in each classroom received only standard feedback after each practice task (SF group); the other half received additionally an individual re‐attributional feedback (RF group) after every third task. Attribution, mathematics self‐concept, and self‐efficacy were measured by an online questionnaire twice a week; learning outcomes in mathematics were measured weekly. Results and Conclusion: Hierarchical analyses showed that re‐attributional feedback led to a more favourable attribution in case of success on stable factors. Especially low‐performing students benefited from this feedback. No effects on attribution in case of failure, self‐efficacy or learning outcomes could be found. Further research could investigate if certain adaptations to the digital re‐attributional feedback is more effective in a real classroom setting and has a broader impact on different students. Lay Description: What is already known about this topic: Working with computers in the classroom and at home is becoming more common.Re‐attributional feedback can increase student's motivation when given directly after solving a task and at a high density.Digital re‐attributive feedback can be given in a high density.Re‐attributional training sessions have been shown to be effective in individual training sessions or outside the students' classroom. What this paper adds: The study took place within a real teaching environment during mathematics class for 4 weeks.Digital re‐attributional feedback sessions were directly integrated into the students' online learning which was part of the teaching plan. The implications of study findings for practitioners: Computer‐based re‐attributional training show some limited effects in regular classroom instruction and could be well integrated in student online learning—when adapted accordingly.Low‐performing students show less favourable attribution than better‐performing students in case of success and benefit the most from re‐attributional training. [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal‐setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person‐centred tool to find out the individual perception of reading functions, reading‐related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. Aims: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. Methods & Procedures: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self‐reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German‐speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. Outcomes & Results: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy‐induced change. We found moderate correlations between outcomes of the questionnaire and text‐level reading speed. Conclusions & Implications: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal‐setting with German‐speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self‐reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject: Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal‐setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person‐centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge: In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German‐speaking PWA. We demonstrated that the German version is accessible for German‐speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self‐reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work?: The German version of the questionnaire could be a valuable self‐reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions. [ABSTRACT FROM AUTHOR]

The impact of algorithms on everyday life is ever increasing. Medicine and public health are not excluded from this development – algorithms in medicine do not only challenge, change and inform research (methods) but also clinical situations. Given this development, questions arise concerning the competency level of prospective physicians, thus medical students, on algorithm related topics. This paper, based on a master's thesis in library and information science written at Humboldt‐Universität zu Berlin, gives an insight into this topic by presenting and analysing the results of a knowledge test conducted among medical students in Germany. F. J. [ABSTRACT FROM AUTHOR]

Background/Objective The objective of this study was to assess how authors of systematic reviews ( SRs) with meta-analyses published in periodontology and implant dentistry evaluate risk of bias ( ROB) in primary studies included in these reviews. Material/Methods A literature search for SRs with meta-analyses was performed in PubMed and Cochrane library databases up to July 20th 2014. The reference lists of included articles were screened for further reviews. The standards of evaluating ROB in primary studies were evaluated by using a 14-item checklist based on the Cochrane approach for evaluating ROB. Standards in ROB evaluations in Cochrane and paper-based SRs were compared using the Fisher's exact test. All searches, data extraction and evaluations were performed independently and in duplicate. Results Seventy SRs were included (45 paper-based and 25 Cochrane SRs, respectively). The median percentage of items addressed was 58% (interquartile range 4-100%). Cochrane SRs more frequently included ROB assessments than paper-based reviews in terms of examiner blinding ( p = 0.0026), selective outcome reporting ( p = 0.0207) and other bias ( p = 0.0241). Conclusions The ROB evaluation in primary studies currently included in SRs with meta-analyses in periodontology and implant dentistry is not sufficiently comprehensive. Cochrane SRs have more comprehensive ROB evaluation than paper-based reviews. [ABSTRACT FROM AUTHOR]

Objectives The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing. Methods Systematic literature search was conducted in nine online resources ( PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association. Results Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant ( P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95% CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity ( I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95% CI: 1.21-1.71, P < 0.0001). Conclusions There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects. [ABSTRACT FROM AUTHOR]

A brief, problem-oriented phase such as an inventing activity is one potential instructional method for preparing learners not only cognitively but also motivationally for learning. Student teachers often need to overcome motivational barriers in order to use computer-based learning opportunities. In a preliminary experiment, we found that student teachers who were given paper-based course material spent more time on follow-up coursework than teachers who were given a well-developed computer-based learning environment (CBLE), leading to higher learning outcomes. Thus, we tested inventing as an instructional method that may help overcome motivational barriers of teachers' use of computer-supported tools or learning environments in our main experimental study (N = 44). As a computer-based environment, we used the 'Assessment of Learning strategies in Learning journals'. The inventing group produced ideas about criteria to evaluate learning strategies based on student cases prior to the learning phase. The control condition read a text containing possible answers to the inventing problem. The inventing activity enhanced motivation prior to the learning phase and assessment skills as assessed by transfer problems. Hence, the inventing activity prepared student teachers to learn from a CBLE in a motivational as well as cognitive way. [ABSTRACT FROM AUTHOR]

The secular trend of reduced physical fitness (PF) leads to increased health risks. The aim of the present paper is to analyse various current factors that affect health behaviour with respect to the course of PF over 2 years. A path analysis combined with a latent growth curve analysis was based on a study that was conducted between June 2008 and June 2010 with 145 primary German school children (52.1% male, average age at baseline 7.95 years ± 0.95). PF was tested with the German Motor Test 6–18. For the mean PF and the course of PF, direct and indirect influences were shown over three levels, including migration background on the first level and physical activity (PA) on the second level. Body mass index (BMI) impacted the mean PF but not the course of PF. The influence of sedentary behaviour on the mean PF was diminished (compared to bivariate analysis) due to its common variance mainly with BMI. PA affected not only current PF in children but also the course of PF (aintercept =.28, P =.001; aslope =.27, P =.21). Consequently, preventive measures should focus on early adoption and maintenance of PA. [ABSTRACT FROM AUTHOR]

Background Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index ( GOHAI). Materials and Methods Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini- Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. Results The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups ( P = 0.030) and were affected by care level ( P = 0.008) and type of dentures worn ( P = 0.006). Conclusions Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health. [ABSTRACT FROM AUTHOR]

Context Basic science teaching in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge to the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasised, theoretical positions on the relative role of this knowledge and the optimal approach to its instruction differ. The present paper addresses whether and to what extent biomedical knowledge is related to the development of clinical knowledge. Methods We analysed repeated-measures data for performances on basic science and clinical knowledge assessments. A sample of 598 medical students on a traditional curriculum participated in the study. The entire study covered a developmental phase of 2 years of medical education. Structural equation modelling was used to analyse the temporal relationship between biomedical knowledge and the acquisition of clinical knowledge. Results At the point at which formal basic science education ends and clinical training begins, students show the highest levels of biomedical knowledge. The present data suggest a decline in basic science knowledge that is complemented by a growth in clinical knowledge. Statistical comparison of several structural equation models revealed that the model to best explain the data specified unidirectional relationships between earlier states of biomedical knowledge and subsequent changes in clinical knowledge. However, the parameter estimates indicate that this association is negative. Discussion Our analysis suggests a negative relationship between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss the limitations of the present study, such as the educational context in which it was conducted and its non-experimental nature. Although the present results do not necessarily contradict the relevance of basic sciences, we speculate on mechanisms that might be related to our findings. We conclude that our results hint at possibly critical issues in basic science education that have been rarely addressed thus far. [ABSTRACT FROM AUTHOR]

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample ( n = 179) that met screening requirements, including subjects with and without mild cognitive impairment ( Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale ( HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective. [ABSTRACT FROM AUTHOR]

The present paper extends the needs-based model of reconciliation to contexts marked by status inequalities rather than by overt intergroup aggression. Specifically, we investigated whether and when members of high-status versus low-status groups experience divergent socio-emotional needs vis-à-vis members of the respective other status group. Building on research informed by social identity theory, we hypothesized that the groups' different positions in the social hierarchy only translate into divergent needs when the status differences are perceived as illegitimate. In Study 1 (N = 130), we tested this prediction by manipulating status and perceived legitimacy of status differences in a setting with artificially created groups. Results confirmed that the need to be socially accepted by members of the other status group was stronger in high-status compared with low-status group members but, as expected, only when the status differences were perceived to be illegitimate. Also as predicted, the need to be empowered by the other status group was stronger in low-status compared with high-status group members, again only under conditions of illegitimate status differences. Study 2 (N = 169) further corroborated our perspective by replicating these findings in a naturalistic intergroup context. Implications for the role of legitimacy perceptions in determining differential socio-emotional needs and for the promotion of sustainable social change are discussed. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]