Carolin Donath

Non-pharmacological, multicomponent group therapy in patients with degenerative dementia: a 12-month randomized, controlled trial

BackgroundCurrently available pharmacological and non-pharmacological treatments have shown only modest effects in slowing the progression of dementia. Our objective was to assess the impact of a long-term non-pharmacological group intervention on cognitive function in dementia patients and on their ability to carry out activities of daily living compared to a control group receiving the usual care.MethodsA randomized, controlled, single-blind longitudinal trial was conducted with 98 patients (follow-up: n = 61) with primary degenerative dementia in five nursing homes in Bavaria, Germany. The highly standardized intervention consisted of motor stimulation, practice in activities of daily living, and cognitive stimulation (acronym MAKS). It was conducted in groups of ten patients led by two therapists for 2 hours, 6 days a week for 12 months. Control patients received treatment as usual. Cognitive function was assessed using the cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-Cog), and the ability to carry out activities of daily living using the Erlangen Test of Activities of Daily Living (E-ADL test) at baseline and after 12 months.ResultsOf the 553 individuals screened, 119 (21.5%) were eligible and 98 (17.7%) were ultimately included in the study. At 12 months, the results of the per protocol analysis (n = 61) showed that cognitive function and the ability to carry out activities of daily living had remained stable in the intervention group but had decreased in the control patients (ADAS-Cog: adjusted mean difference: -7.7, 95% CI -14.0 to -1.4, P = 0.018, Cohens d = 0.45; E-ADL test: adjusted mean difference: 3.6, 95% CI 0.7 to 6.4, P = 0.015, Cohens d = 0.50). The effect sizes for the intervention were greater in the subgroup of patients (n = 50) with mild to moderate disease (ADAS-Cog: Cohens d = 0.67; E-ADL test: Cohens d = 0.69).ConclusionsA highly standardized, non-pharmacological, multicomponent group intervention conducted in a nursing-home setting was able to postpone a decline in cognitive function in dementia patients and in their ability to carry out activities of daily living for at least 12 months.Trial Registrationhttp://www.isrctn.com Identifier: ISRCTN87391496

Is parenting style a predictor of suicide attempts in a representative sample of adolescents

BackgroundSuicidal ideation and suicide attempts are serious but not rare conditions in adolescents. However, there are several research and practical suicide-prevention initiatives that discuss the possibility of preventing serious self-harm. Profound knowledge about risk and protective factors is therefore necessary. The aim of this study is a) to clarify the role of parenting behavior and parenting styles in adolescents’ suicide attempts and b) to identify other statistically significant and clinically relevant risk and protective factors for suicide attempts in a representative sample of German adolescents.MethodsIn the years 2007/2008, a representative written survey of N = 44,610 students in the 9th grade of different school types in Germany was conducted. In this survey, the lifetime prevalence of suicide attempts was investigated as well as potential predictors including parenting behavior. A three-step statistical analysis was carried out: I) As basic model, the association between parenting and suicide attempts was explored via binary logistic regression controlled for age and sex. II) The predictive values of 13 additional potential risk/protective factors were analyzed with single binary logistic regression analyses for each predictor alone. Non-significant predictors were excluded in Step III. III) In a multivariate binary logistic regression analysis, all significant predictor variables from Step II and the parenting styles were included after testing for multicollinearity.ResultsThree parental variables showed a relevant association with suicide attempts in adolescents – (all protective): mother’s warmth and father’s warmth in childhood and mother’s control in adolescence (Step I). In the full model (Step III), Authoritative parenting (protective: OR: .79) and Rejecting-Neglecting parenting (risk: OR: 1.63) were identified as significant predictors (p < .001) for suicidal attempts. Seven further variables were interpreted to be statistically significant and clinically relevant: ADHD, female sex, smoking, Binge Drinking, absenteeism/truancy, migration background, and parental separation events.ConclusionsParenting style does matter. While children of Authoritative parents profit, children of Rejecting-Neglecting parents are put at risk – as we were able to show for suicide attempts in adolescence. Some of the identified risk factors contribute new knowledge and potential areas of intervention for special groups such as migrants or children diagnosed with ADHD.

Effects of Multimodal Nondrug Therapy on Dementia Symptoms and Need for Care in Nursing Home Residents with Degenerative Dementia: A Randomized‐Controlled Study with 6‐Month Follow‐Up

To determine the efficacy of multimodal, nondrug therapy on symptoms of dementia and need for care in institutionalized individuals with degenerative dementia.

Effects of general practitioner training and family support services on the care of home-dwelling dementia patients - Results of a controlled cluster-randomized study

BackgroundMore than 90% of dementia patients are cared for by their general practitioners, who are decisively involved in the diagnosis, therapy and recommendation of support services. Objective: To test whether special training of general practitioners alters the care of dementia patients through their systematic recommendation of caregiver counseling and support groups.Method129 general practitioners enrolled 390 dementia patients and their informal caregivers in a prospective, three-arm cluster-randomized 2-year study. Arm A constituted usual care, in Arm B and C support groups and caregiver counseling (in Arm B one year after baseline, in Arm C at baseline) were recommended by the general practitioners. The general practitioners received arm-specific training. Diagnostic and therapeutic behavior of physicians was recorded at baseline. Informal caregivers were questioned in follow-up after 2 years about the utilization of support services.ResultsThe diagnostic behavior of the general practitioners conforms to relevant guidelines. The procedure in newly-diagnosed patients does not differ from previously diagnosed patients with the exception of the rate of referral to a specialist. About one-third of the newly-diagnosed dementia patients are given an anti-dementia drug. The utilization of support groups and counseling increased five- and fourfold, respectively. Utilization of other support services remained low (< 10%), with the exception of home nursing and institutional short-term nursing.ConclusionTrained general practitioners usually act in conformity with guidelines with respect to diagnosing dementia, and partly in conformity with the guidelines with respect to recommended drug therapy. Recommendations of support services for informal caregivers by the general practitioner are successful. They result in a marked increase in the utilization rate for the recommended services compared to offers which are not recommended by the general practitioner.Trial registrationISRCTN68329593

Support groups for dementia caregivers--predictors for utilisation and expected quality from a family caregiver's point of view: a questionnaire survey part I*.

BackgroundSupport groups have proved to be effective in reducing the burden on family caregivers of dementia patients. Nevertheless, little is known about the factors that influence utilisation or quality expectations of family caregivers. These questions are addressed in the following paper.MethodsThe cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in Germany. Qualitative and quantitative data from 404 caregivers were analysed using content analysis and binary logistic regression analysis.ResultsThe only significant predictor for utilisation is assessing how helpful support groups are for the individual care situation. Family caregivers all agree that psycho-educative orientation is a priority requirement.ConclusionsIn order to increase the rate of utilisation, family caregivers must be convinced of the relevant advantages of using support groups. Support groups which offer an exchange of experiences, open discussion, information and advice meet the requirements of family caregivers.

From board to bedside - training the communication competences of medical students with role plays

BackgroundRole plays and standardized patients are often used in medical education and have proven to be effective tools for enhancing the communication skills of medical students. Most course concepts need additional time and teaching staff, and there are only a few studies about role plays in the preclinical segment.MethodsWe developed a highly consolidated concept for the curricular course of 2nd-year medical students, including ten role plays about five subjects: anamnesis, shared decision making, prevention, breaking bad news, and so-called “difficult interactions”. Before the course, all students were asked about their expectations and attitudes toward the course. After the course, all students rated the course, their individual learning progress, whether their expectations had been fulfilled, and re-evaluated their attitudes. Questionnaires were self-report measures and had a quantitative and a short qualitative section and were analyzed with descriptive statistics. Group differences (sex, age, role played) were evaluated with t tests at a Bonferonni-corrected significance level of p = .03 and the non-parametric U-tests.ResultsImplementing this practical course concept is possible without incurring additional costs. This paper not only shows how that can be done but also provides 5 examples of role scripts for different training subjects. The course concept was highly appreciated by the students. More than 75% felt that they had learned important communication techniques and would be better able to handle difficult situations. Playing the doctor’s role was felt to be more useful than playing the patient’s role. Women admitted a higher degree of shyness in the beginning and gave higher ratings to their learning progress than men. Students’ most frequent wish in the qualitative analysis was to be able to play the doctor’s role at least once. The students’ answers showed a differentiated pattern, thus suggesting that the influence of social desirability was minimal.ConclusionsPractical skills can be taught successfully in the preclinical stage of medical education even without an increase in resources. The course concept described in this article provides an effective means by which to do so.

Counselling for dementia caregivers—predictors for utilization and expected quality from a family caregiver’s point of view

Caregiver counselling has proved to be effective in reducing the burden of family caregivers of dementia patients. Nevertheless, little is known about the influencing factors for utilization and quality expectations of family caregivers. In this article, we address the following questions on the theoretical base of the Andersen/Newman model: Which variables of the care situation, the caregivers and their attitudes act as predictors for the utilization of caregiver counselling? What are the views of caregivers about the quality of caregiver counselling? The cross-sectional study was carried out as an anonymous written survey of family caregivers of dementia patients in four regions, both urban and rural, of Germany. Quantitative and qualitative data from 404 family caregivers were analysed using binary logistic regression analysis and qualitative content analysis, respectively. The only significant predictor for utilization is the assessment of how helpful caregiver counselling is for the individual care situation. In the sensitivity analysis ‘accessibility of caregiver counselling’ was additionally predictive for usage. Family caregivers most frequently expressed a wish for advice about further ‘support offers’ by qualified counsellors. In order to increase the rate of utilization, family caregivers must be convinced of the relevant advantages of using caregiver counselling. Counselling services should provide information about further support offers and give practical help in filling out application forms.

Pflegekurse – Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger eines Demenzpatienten

AIM Which variables are predictors for the utilisation of caregiver skill training and what are the views of caregivers about its quality? METHOD A written survey of 404 family caregivers of dementia patients was carried out. RESULTS The estimation of helpfulness of skill training, lower level of education of the caregiver and higher age of the dementia patient are significant predictors. Caregivers most frequently expressed a wish for practical instruction on caregiving activities.

Vereinbarkeit von Familie und Beruf bei Beschäftigten im Gesundheitswesen als Handlungsfeld der Versorgungsforschung

Hintergrund/Ziele Beschäftigte im Gesundheitswesen sind mit besonderen beruflichen Rahmenbedingungen und Anforderungen konfrontiert, die sich auf das Verhältnis von Familie und Arbeit/Beruf auswirken können und mittelbar auch die Qualität der Gesundheitsversorgung beeinflussen. Ziel des vorliegenden Beitrags ist es, einen Überblick über den Forschungsstand zu diesem Thema zu geben. Dieser ist für die Versorgungsforschung von Relevanz. Er kann als Ausgangspunkt dafür dienen, Strukturen im Gesundheitswesen (auch in ländlichen Regionen) dahingehend zu verändern, dass sie eine bessere Vereinbarkeit von Familie und Beruf ermöglichen. Methode Es wurde eine systematische nationale und internationale Literaturrecherche in Form eines Scoping Review durchgeführt, um den aktuellen Forschungsstand zur Vereinbarkeit von Familie und Gesundheitsberuf zu dokumentieren. Als inhaltliche Suchkriterien wurden definiert: Vereinbarkeit von Beruf und Familie (allgemein); Vereinbarkeitserleben und -konflikte bei Gesundheitsberufen; Vereinbarkeit von Familie und Gesundheitsberuf im ländlichen Raum; Interventionsansätze zur Förderung der Vereinbarkeit von Beruf und Familie. Im Ergebnis eines mehrstufigen Selektionsprozesses wurden 145 Publikationen in die inhaltliche Auswertung einbezogen. Ergebnisse Die dokumentierte Literatur bezieht sich schwerpunktmäßig auf die Berufsgruppen Ärzte und beruflich Pflegende, für andere Berufsgruppen liegen kaum Arbeiten vor. Die methodische Qualität der Studien ist meist niedrig, Metaanalysen liegen nicht vor. Mehrere Arbeiten dokumentieren eine Unzufriedenheit bei Ärzten und beruflich Pflegenden bzgl. Möglichkeiten der Vereinbarkeit von Familie und Beruf. Es konnten nur wenige Interventionsstudien zur Förderung der Vereinbarkeit von Familie und Beruf gefunden werden, diese sind wiederum nur teilweise spezifisch auf Gesundheitsberufe ausgerichtet. Defizite bestehen zudem hinsichtlich der Vernetzung mit Fragen der Verbesserung der Gesundheitsversorgung in ländlichen Gebieten. Schlussfolgerung Zur Thematik „Vereinbarkeit von Familie und Gesundheitsberuf“ existiert national wie international nur wenig systematische Forschung. Insbesondere zur Evaluation von Maßnahmen bestehen Defizite. Der Literaturüberblick ermöglicht die Ableitung von Ansatzpunkten, um eine Verbesserung der Vereinbarkeit von Familie und Beruf zu erreichen.BACKGROUND Healthcare professionals are confronted with specific work-related demands that influence work-family relations and might indirectly affect the quality of healthcare. This paper seeks to provide an overview of the current state of research on this topic of relevance to health services research. The overview may serve as a starting point for modifying structures in the healthcare system (especially in rural regions) with the aim of improving work-family compatibility. METHODS A systematic national and international literature search was conducted in terms of a scoping review. The following criteria/contents to be covered in publications were defined: work-family compatibility; work-family interface and work-family conflict in employees working in healthcare; healthcare professions in rural areas and links with work-family issues; interventions to improve work-family compatibility. 145 publications were included in the overview. RESULTS The available literature focuses on physicians and nursing staff while publications on other professions are largely lacking. The methodological quality of existing studies is mostly low, including a lack of meta-analyses. Several studies document dissatisfaction in physicians and nursing staff regarding reconciliation of work and family life. Only few intervention studies were found that seek to improve work-life compatibility; few of them focus on employees in healthcare. There are also deficits with respect to linking work-family issues with aspects of healthcare in rural areas. CONCLUSIONS There is a shortage of systematic national and international research regarding work-family compatibility, especially when it comes to the evaluation of interventions. The overview provides starting points for improving work-family compatibility in healthcare.

Health Services Utilization by Community-Dwelling Dementia Patients and Their Family Caregivers

Background In research as well as in the practice of home-living persons with dementia and their family caregivers, influencing the probability of institutionalization is considered an important characteristic of home care. Two presented studies implementing the behavioral model of Andersen provide information on predictors of utilization of care and support services, the utilization of nondrug therapies, and the utilization of health insurance and long-term care insurance benefits.