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Abstract: Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.

Background Person-centredness is considered as best practice for people with dementia. A frequently used instrument to assess person-centredness of a care environment is the Person-centred Climate Questionnaire (PCQ). The questionnaire comprises of 14 items with the three subscales a climate of safety, a climate of everydayness and a climate of community. Aim The aim of the study is to describe the translation process of the English language Person-centred Climate Questionnaire (Staff version, Patient version, Family version) into German language (PCQ-G) and to evaluate the first psychometric properties of the German language Person-centred Climate Questionnaire– Staff version (PCQ-G-S). Methods We conducted a cross-sectional study. The three versions of the 14-item English PCQ were translated into German language (PCQ-G) based on the recommendations for cross-cultural adaption of measures. Item distribution, internal consistency and structural validity of the questionnaire were assessed among nursing home staff (PCQ-G-S). Item distribution was calculated using descriptive statistics. Structural validity was tested using principal component analysis (PCA), and internal consistency was assessed for the resulting subscales using Cronbach’s alpha. Data collection took place from May to September 2021. Results A total sample of 120 nurses was included in the data analysis. Nine out of 14 items of the PCQ-G-S demonstrated acceptable item difficulty, while five times showed a ceiling effect. The PCA analysis demonstrated a strong structural validity for a three-factor solution explaining 68.6% of the total variance. The three subscales demonstrated a strong internal consistency with Cronbach’s alpha scores of 0.8 for each of the subscales. Conclusion The analysis of the 14-item German version (PCQ-G-S) showed first evidence for a strong internal consistency and structural validity for evaluating staff perceptions of the person-centredness in German nursing homes. Based on this, further investigations for scale validity of the PCQ-G versions should be carried out.

Background: Geriatric patients require holistic care in order to meet their complex care needs. The project RubiN (Continuous Care in a Regional Network) provides case and care management (CCM) for older people to address these needs in a primary care setting in Germany. This study aimed to explore the experiences of health care professionals who provided CCM for geriatric patients. Methods: Focus group interviews with general practitioners (GPs), health care assistants (HCAs), and case managers (CMs) were conducted. Transcribed data were analyzed by using qualitative content analysis. Results: Ten focus group discussions (n = 15 GPs, n = 14 HCAs, n = 17 CMs) were conducted. The different health care professionals emphasized the importance of a holistic care approach to geriatric care. Moreover, the GPs stated that the CMs supported the patients in organizing their care. A CCM could help encourage patients to remain at their own homes, which would have an effect on patients’ quality of life and satisfaction. Conclusion: A well-functioning and effective cooperation between those health professionals involved is a prerequisite for a trustful relationship in the holistic care of older people. This creates a feeling of security for all people involved in the care process.

Sleep disturbances occur frequently in people with dementia with a reported prevalence of up to 40%. Common problems are increased number and duration of awakenings and increased percentage of light sleep. Sleep disturbances are associated with a number of problems for people with dementia, their relatives, and carers. In people with dementia, they may lead to worsening of cognitive symptoms, challenging behaviours such as restlessness or wandering, and further harms, such as accidental falls. Sleep disturbances are also associated with significant carer distress and have been reported as a factor contributing to institutionalisation of people with dementia. As pharmacological approaches have shown unsatisfactory results, there is a need to synthesise the research evidence on non-pharmacological strategies to improve sleep in people with dementia. As interventions are often complex, consisting of more than one active component, and implemented in complex contexts, it may not be easy to identify effective intervention components.To evaluate the benefits and harms of non-pharmacological interventions on sleep disturbances in people with dementia compared to usual care, no treatment, any other non-pharmacological intervention, or any drug treatment intended to improve sleep, and to describe the components and processes of any complex intervention included.We used standard, extensive Cochrane search methods. The latest search was 13 January 2022.We included individually or cluster-randomised controlled trials in people with dementia comparing non-pharmacological interventions to improve sleep compared to usual care or to other interventions of any type. Eligible studies had to have a sleep-related primary outcome. We included people with a diagnosis of dementia and sleep problems at baseline irrespective of age, type of dementia, severity of cognitive impairment, or setting. Studies reporting results on a mixed sample (e.g. in a nursing home) were only considered for inclusion if at least 80% of participants had dementia.We used standard Cochrane methods. Our primary outcomes were 1. objective sleep-related outcomes (e.g. total nocturnal sleep time, consolidated sleep time at night, sleep efficiency, total wake time at night (or time spent awake after sleep onset), number of nocturnal awakenings, sleep onset latency, daytime/night-time sleep ratio, night-time/total sleep ratio over 24 hours) and 2.Our secondary outcomes were 3. subjective sleep-related outcomes, 4. behavioural and psychological symptoms of dementia, 5. quality of life, 6. functional status, 7. institutionalisation, 8. compliance with the intervention, and 9. attrition rates. We used GRADE to assess the certainty of evidence and chose key outcomes to be included in summary of findings tables.We included 19 randomised controlled trials with 1335 participants allocated to treatment or control groups. Fourteen studies were conducted in nursing homes, three included community residents, one included 'inpatients', one included people from a mental health centre, and one included people from district community centres for older people. Fourteen studies were conducted in the US. We also identified nine ongoing studies. All studies applied one or more non-pharmacological intervention aiming to improve physiological sleep in people with dementia and sleep problems. The most frequently examined single intervention was some form of light therapy (six studies), five studies included physical or social activities, three carer interventions, one daytime sleep restriction, one slow-stroke back massage, and one transcranial electrostimulation. Seven studies examined multimodal complex interventions. Risk of bias of included studies was frequently unclear due to incomplete reporting. Therefore, we rated no study at low risk of bias. We are uncertain whether light therapy has any effect on sleep-related outcomes (very low-certainty evidence). Physical activities may slightly increase the total nocturnal sleep time and sleep efficiency, and may reduce the total time awake at night and slightly reduce the number of awakenings at night (low-certainty evidence). Social activities may slightly increase total nocturnal sleep time and sleep efficiency (low-certainty evidence). Carer interventions may modestly increase total nocturnal sleep time, may slightly increase sleep efficiency, and may modestly decrease the total awake time during the night (low-certainty evidence from one study). Multimodal interventions may modestly increase total nocturnal sleep time and may modestly reduce the total wake time at night, but may result in little to no difference in number of awakenings (low-certainty evidence). We are uncertain about the effects of multimodal interventions on sleep efficiency (very low-certainty evidence). We found low-certainty evidence that daytime sleep restrictions, slow-stroke back massage, and transcranial electrostimulation may result in little to no difference in sleep-related outcomes. Only two studies reported information about adverse events, detecting only few such events in the intervention groups.Despite the inclusion of 19 randomised controlled trials, there is a lack of conclusive evidence concerning non-pharmacological interventions for sleep problems in people with dementia. Although neither single nor multimodal interventions consistently improved sleep with sufficient certainty, we found some positive effects on physical and social activities as well as carer interventions. Future studies should use rigorous methods to develop and evaluate the effectiveness of multimodal interventions using current guidelines on the development and evaluation of complex interventions. At present, no single or multimodal intervention can be clearly identified as suitable for widespread implementation.

Zusammenfassung Hintergrund Versorgungskonzepte, die zu einer Entlastung der pflegenden Angehörige beitragen, werden dringend benötigt. „Regional ununterbrochen betreut im Netz“ (RubiN), welches mit einem Care-und-Case-Management in Ärztenetzen die Versorgung von geriatrischen Patienten unterstützen soll, zielt auch darauf ab, Angehörige zu entlasten. Ziele waren daher die Entwicklung und psychometrische Überprüfung eines Fragebogens, der die Zufriedenheit und Akzeptanz mit der Versorgung durch ein Case Management (CM) aus Perspektive der Angehörigen erfasst. Methodik Es wurde ein „Mixed-methods“-Design zur Konzeptualisierung des Fragebogens gewählt. Neben der Entwicklung des Fragebogens anhand qualitativer Interviews sowie eigener Projekt- und Studienerfahrungen erfolgten die Pilotierung und anschließende psychometrische Überprüfung des Fragebogens in den 5 teilnehmenden RubiN-Ärztenetzen. Von Mai bis August 2020 fand die Befragung in den Ärztenetzen statt. Jedes der 5 beteiligten Ärztenetze erhielt ein Set mit je 50 Fragebogen für Angehörige. Das Fragebogenkonstrukt wurde psychometrisch überprüft. Ergebnisse Der konzipierte Fragebogen bestand aus 11 Items. Insgesamt nahmen 137 Angehörige an der Befragung teil (Rücklaufquote 55 %). Die Angehörigen waren mit der angebotenen Versorgung sehr zufrieden (78,1 %). Des Weiteren zeigten die Daten sehr geringe fehlende Werte auf. Die 11 Items des Fragebogens luden auf 2 Faktoren. Faktor 1 „Auswirkungen durch die Koordination“ wies eine interne Konsistenz von 0,843 und Faktor 2 „Erreichbarkeit“ eine interne Konsistenz von 0,683 auf. Diskussion Der Fragenbogen umfasst die Akzeptanz und Zufriedenheit der angebotenen Versorgungselemente für Angehörige mit einem geriatrischen CM und zeichnet sich mit 11 Items durch seine Kürze aus.

Purpose Coordinated care is important for the health and well-being of geriatric patients. However, continuity of care is lacking in many countries. Several studies have shown that case management can help to meet these requirements in health care and investigated positive effects. The project RubiN (Regional ununterbrochen betreut im Netz; Continuous care in a regional network) was developed to provide regional care- and case management for outpatient care of the elderly (age >70 years) in a primary care setting. The aim of this qualitative approach was to explore experiences and attitudes of geriatric patients towards the newly developed complex care- and case-management intervention RubiN. Patients and methods Qualitative interviews with a purposive sample of geriatric patients enlisted in the RubiN intervention networks were conducted. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. Results Forty-four telephone interviews were performed. Two key categories were identified to describe patients' experiences regarding care delivered by a care- and case manager (CCM), namely "role of CCM" and "changes through RubiN". Results demonstrated that care performed by CCMs is perceived positively by geriatric patients. A main finding of this study was that geriatric patients experienced a sense of security through the care provided by CCMs. CCMs were perceived as highly competent people, having all the necessary skills to provide continuity of care. Conclusion This study illustrates the importance of trust between care provider and care recipient. It also shows that geriatric patients appreciate the continuous, professional care and structural and functional support provided by qualified CCMs.

Background Sleep disturbances are common in people with dementia. In nursing homes, this is frequently associated with residents’ challenging behavior and potentially with nurses’ burden. This study examined nurses’ burden associated with nursing home residents’ sleep disturbances. Methods A multicenter cross-sectional study was conducted. Nurses’ burden associated with residents’ sleep disturbances was assessed using the Sleep Disorder Inventory (SDI). Additionally, the proportion of nurses’ total burden associated with sleep disturbances of residents with dementia was assessed. A linear mixed regression model was used to investigate the association with nurses’, residents’ and institutional characteristics. Results One hundred eleven nurses from 38 nursing homes were included. 78.4% stated to be regularly confronted with residents’ sleep disturbances during nightshifts, causing distress. The mean proportion of nurses‘ total burden caused by residents‘ sleep disturbances was 23.1 % (SD 18.1). None of the investigated characteristics were significantly associated with nurses’ total burden. Conclusions Nurses report burden associated with sleep disturbances as common problem. There is a need to develop effective interventions for sleep problems and to train nurses how to deal with residents’ sleep disturbances.

Background Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a variety of musculoskeletal symptoms in the lower extremity, such as knee or hip pain. The standard conservative treatment for flatfoot deformity is exercise therapy or treatment with foot orthoses. Foot orthoses are prescribed for various foot complaints. However, the evidence for the provision of foot orthoses is inconsistent. The aim of this systematic review is to synthesize the evidence of foot orthoses for adults with flatfoot. Methods A computerized search was conducted in August 2021, using the databases PubMed, Scopus, Pedro, Cochrane Library, and the Cochrane Central Register of Controlled Trials. Intervention studies of any design investigating the effects of foot orthoses were included, apart from case studies. Two independent reviewers assessed all search results to identify eligible studies and to assess their methodological quality. Results A total of 110 studies were identified through the database search. 12 studies met the inclusion criteria and were included in the review. These studies investigated prefabricated and custom-made foot orthoses, evaluating stance and plantar pressure during gait. The sample sizes of the identified studies ranged from 8 to 80. In most of the studies, the methodological quality was low and a lack of information was frequently detected. Conclusion There is a lack of evidence on the effect of foot orthoses for flatfoot in adults. This review illustrates the importance of conducting randomized controlled trials and the comprehensive development of guidelines for the prescription of foot orthoses. Given the weak evidence available, the common prescription of foot orthoses is somewhat surprising.

Zusammenfassung Hintergrund Der Begriff „Telemedizin“ beschreibt die Bereitstellung von medizinischen Dienstleistungen mit Hilfe von Informations- und Kommunikationstechnologien in einer Situation, in der die Beteiligten sich an unterschiedlichen Orten befinden. Wahrend in Forschungsprojekten in Deutschland telemedizinische Anwendungen noch haufig pilotiert werden, sind diese bisher selten Bestandteil der alltaglichen Versorgung geworden. Um Hinweise darauf zu finden, warum der Wissenstransfer in die Praxis bisher zogerlich gelingt, besteht die Notwendigkeit, telemedizinische Projekte nach implementierungswissenschaftlichen Aspekten zu untersuchen. Methode Es wurde eine systematische Recherche in den elektronischen Datenbanken PubMed, Web of Science und ACM Digital Library durchgefuhrt, indem diese mit einer komplexen Suchstrategie auf telemedizinische Projekte in Deutschland mit dem Fokus auf die Versorgung landlicher Regionen durchsucht wurden. Zur Bewertung und Einordung der Publikationen wurden die Kriterien und Domanen des Model for Assessment of Telemedicine (MAST) herangezogen. Ergebnisse Insgesamt wurden 336 Publikationen identifiziert, von denen letztendlich 16 in die Analyse eingeschlossen werden konnten. Ein Grosteil der eingeschlossenen Arbeiten befasst sich dem Krankheitsbild Schlaganfall und der Implementierung von Telemedizinnetzwerken. Die Analyse nach MAST zeigt, dass die meisten Publikationen wesentliche Betrachtungen bezuglich der Implementierung von telemedizinischen Projekten auslassen. Schlussfolgerung Publikationen zu telemedizinischen Projekten sind oft durch unsystematische Vorgehensweisen gepragt. Das MAST Instrument zeigt Moglichkeiten auf, wie die Betrachtungsweisen bei telemedizinischen Projekten zukunftig erweitert werden konnten, um die Nachhaltigkeit und die Realisierbarkeit dieser prototypischen telemedizinischen Anwendungen zu gewahrleisten.

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care- and case-management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care- and case-management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community-based care- and case-management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care- and case-managers. A care- and case-management affected caregiving per se as well as the patient's and family caregiver's well-being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care- and case-managers. Establishing networks between the patients, family caregivers, care- and case-managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community-based care- and case-management can play an important role in detecting, facilitating and preventing family caregiver burden.

Background Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no “gold standard” intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. Methods This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two “sleep nurses” as change agents per nursing home, (3) a basic education course for nursing staff: “Sleep problems in dementia”, (4) an advanced education course for nursing staff: “Tailored problem-solving” (two workshops), (5) workshops: “Development of an institutional sleep-promoting concept” (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and “One Minute Wonder” poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. Conclusions It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. Trial registration Current controlled trials: ISRCTN36015309. Date of registration: 06/11/2020.

To ease the burden for family caregivers healthcare concepts are urgently needed. The healthcare concept continuous care in a regional network (RubiN) offers a care and case management in physician networks for geriatric patients and aims to relieve family caregivers. The aim of the study was to develop and to test the psychometric properties of a questionnaire that evaluates the satisfaction and acceptance of the healthcare provided by case management (CM) from the perspective of family caregivers.A mixed methods design was used to develop the questionnaire based on qualitative interviews, a literature search and own project experiences. After a pilot run the subsequent data acquisition took place in the participating RubiN physician networks from May to August 2020. Each of the 5 participating networks received a set of 50 questionnaires for family caregivers. The psychometric properties of the questionnaire were evaluated.The questionnaire consisted of 11 items. A total of 137 family caregivers participated in the survey (response rate 55%). Overall, the family caregivers were very satisfied (78.1%) with the care offered. There were only a few missing values in the data. The 11 items in the questionnaire loaded on 2 factors. The first factor called effects from coordination showed an internal consistency of 0.843 and for the second factor called accessibility an internal consistency of 0.683 was observed.The questionnaire with 11 items is characterized by its brevity and includes the acceptance and satisfaction of the care elements offered for family caregivers in a geriatric CM.HINTERGRUND: Versorgungskonzepte, die zu einer Entlastung der pflegenden Angehörige beitragen, werden dringend benötigt. „Regional ununterbrochen betreut im Netz“ (RubiN), welches mit einem Care-und-Case-Management in Ärztenetzen die Versorgung von geriatrischen Patienten unterstützen soll, zielt auch darauf ab, Angehörige zu entlasten. Ziele waren daher die Entwicklung und psychometrische Überprüfung eines Fragebogens, der die Zufriedenheit und Akzeptanz mit der Versorgung durch ein Case Management (CM) aus Perspektive der Angehörigen erfasst.Es wurde ein „Mixed-methods“-Design zur Konzeptualisierung des Fragebogens gewählt. Neben der Entwicklung des Fragebogens anhand qualitativer Interviews sowie eigener Projekt- und Studienerfahrungen erfolgten die Pilotierung und anschließende psychometrische Überprüfung des Fragebogens in den 5 teilnehmenden RubiN-Ärztenetzen. Von Mai bis August 2020 fand die Befragung in den Ärztenetzen statt. Jedes der 5 beteiligten Ärztenetze erhielt ein Set mit je 50 Fragebogen für Angehörige. Das Fragebogenkonstrukt wurde psychometrisch überprüft.Der konzipierte Fragebogen bestand aus 11 Items. Insgesamt nahmen 137 Angehörige an der Befragung teil (Rücklaufquote 55 %). Die Angehörigen waren mit der angebotenen Versorgung sehr zufrieden (78,1 %). Des Weiteren zeigten die Daten sehr geringe fehlende Werte auf. Die 11 Items des Fragebogens luden auf 2 Faktoren. Faktor 1 „Auswirkungen durch die Koordination“ wies eine interne Konsistenz von 0,843 und Faktor 2 „Erreichbarkeit“ eine interne Konsistenz von 0,683 auf.Der Fragenbogen umfasst die Akzeptanz und Zufriedenheit der angebotenen Versorgungselemente für Angehörige mit einem geriatrischen CM und zeichnet sich mit 11 Items durch seine Kürze aus.

Background:Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents.Methods:This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies’ methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria.Results:A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories “daytime activities,” “nighttime activities,” “staff training,” and “light exposure.” The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories.Conclusions:The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.

Allgemeinmedizin zeichnet sich als generalistische medizinische Disziplin auch durch seinen holistischen Zugang aus. In den letzten Jahren ist der Begriff Coaching ein vielfaltig verwendeter und zunehmend prasenter, der zunehmend auch im Gesundheitsbereich verwendet wird. Ziel des Beitrags war es, der Frage nachzugehen, wie Coaching aus der Perspektive der Allgemeinmedizin zu definieren ist und welche Konsequenzen daraus fur die Versorgung abzuleiten sind. Es wurde ein systematisches Review mit den Schlusselwortern „coaching“, „health coaching“, „resilience coaching“, „primary care“, „family medicine“ and „family physician“ in PubMed, Web of Science und EMBASE sowie eine Handrecherche durchgefuhrt. Insgesamt wurden 2370 Publikationen gesichtet, von denen drei zur Beantwortung der Fragestellung herangezogen werden konnten. Eine einheitliche Definition zu Coaching existiert nicht. Ublicherweise wird damit ein klientenbezogener Prozess bezeichnet, der darauf abzielt, vom Klienten definierte Ziele zu erreichen. Coaching soll dazu befahigen, sich aktiver fur die Verbesserung der eigenen Gesundheit einzusetzen. Hierzu wird eine Vielzahl von Methoden verwendet, die teilweise bereits von Allgemeinarzten verwendet werden. Ohne es so zu benennen werden Coaching Methoden in der Allgemeinmedizin schon angewendet. Es gibt Hinweise darauf, dass es weitere Methoden gibt, die erfolgreich in der hausarztlichen Patientenversorgung eingesetzt werden konnen. Eine weitere wissenschaftliche Evaluation dieser Methoden erscheint vielversprechend.

Objective The aim of this systematic review was to identify quality indicators (QI) developed for health care for refugees. Methods We conducted a systematic review of international QI databases such as the Agency for Health care Research and Quality in addition to a systematic search in PubMed, Cochrane library and Web of Science, using the terms “refugee” and “quality indicator”, complemented by a search in reference lists and grey literature. All papers which included QIs for refugees, especially for health care were included. In a first step all existing QIs were screened for their relevance to refugees. In a second step, all health care QIs were extracted. In a final step, these health care QIs were classified into process, structure and outcome indicators. Results Of 474 papers, 23 were selected for a full-text review. Of these 23 publications, 6 contained 115 QIs for health and health care for refugees. The main health care topics identified were reproductive health, health care service and health status. Conclusions Most indicators were indicators for outcome and structure quality, the smallest group were process indicators. Within the area of refugee health care, most QIs that have been found were QIs regarding reproductive health. QI databases do not yet include indicators specifically related to refugees.

Background The treatment of multimorbid patients is one crucial task in general practice as multimorbidity is highly prevalent in this setting. However, there is little evidence how to treat these patients and consequently there are but a few guidelines that focus primarily on multimorbidity. Big data analytics are defined as a method that obtains results for high volume data with high variety generated at high velocity. Yet, the explanatory power of these results is not completely understood. Nevertheless, addressing multimorbidity as a complex condition might be a promising field for big data analytics. The aim of this scoping review was to evaluate whether applying big data analytics on patient data does already contribute to the treatment of multimorbid patients in general practice. Methods In January 2018, a review searching the databases PubMed, The Cochrane Library, and Web of Science, using defined search terms for “big data analytics” and “multimorbidity”, supplemented by a search of grey literature with Google Scholar, was conducted. Studies were not filtered by type of study, publication year or language. Validity of studies was evaluated independently by two researchers. Results In total, 2392 records were identified for screening. After title and abstract screening, six articles were included in the full-text analysis. Of those articles, one reported on a model generated with big data techniques to help caring for one group of multimorbid patients. The other five articles dealt with the analysis of multimorbidity clusters. No article defined big data analytics explicitly. Conclusions Although the usage of the phrase “Big Data” is growing rapidly, there is nearly no practical use case for big data analysis techniques in the treatment of multimorbidity in general practice yet. Furthermore, in publications addressing big data analytics, the term is rarely defined. However, possible models and algorithms to address multimorbidity in the future are already published. Electronic supplementary material The online version of this article (10.1186/s12875-019-0928-5) contains supplementary material, which is available to authorized users.

BACKGROUND Sleep disturbances and insomnia occur frequently in people with dementia and are associated with a number of problems for affected persons, relatives, and carers. OBJECTIVE Considering the lack of high-quality data especially from Germany, this study aimed to determine the prevalence of sleep disturbances and possible associated factors with in German nursing home residents. METHODS Multicenter cross-sectional study. Nursing homes in Northern Germany were randomly selected from nursing home registers and contacted consecutively. All residents with cognitive impairment living in the nursing homes were included. Data collection took place between June and December 2017. In addition to the characteristics of nursing homes, nurses, and residents, sleep disturbances of residents with dementia were assessed using the Sleep Disorder Inventory (SDI). Descriptive statistics were applied for prevalence assessment. A generalized linear mixed model was used to investigate associated factors. RESULTS 38 nursing homes and 1,187 residents with cognitive impairment were included in the study. Sleep disturbances were reported for 23% of residents with pronounced differences between centers, ranging from 0-85%. The prescription of psychotropic drugs (OR 4.47; 95% CI 3.06-6.43; p

The term telemedicine describes the delivery of healthcare services through the use of information and communication technologies in a situation where the actors are at different locations. While telemedical applications are piloted in research projects in Germany, they have rarely become part of everyday care. In order to find indications as to why the transfer of knowledge into practice has so far been slow, it is necessary to examine telemedical projects for aspects of implementation science.A systematic search looking for telemedical projects in Germany was conducted in the electronic databases PubMed, Web of Science and ACM Digital Library using a complex search strategy. The criteria and domains of the Model for Assessment of Telemedicine (MAST) were used to evaluate the publications.A total of 336 publications were identified, 16 of which were ultimately included in the analysis. Much of the work deals with stroke and the implementation of telemedicine networks. The analysis according to MAST shows that most publications omit essential considerations.Publications on telemedical projects are often characterized by unsystematic approaches. The MAST instrument identifies areas where the approaches to telemedical projects could be extended in the future to ensure the sustainability and feasibility of these prototypical telemedical applications.

This is the protocol for a review and there is no abstract. The objectives are as follows: To identify, appraise and summarise the best evidence for the efficacy of non-pharmacological interventions for sleep disturbances in people with dementia. To describe the components and processes of any complex intervention used.