Multimodal Approaches in the Treatment of Chronic Peripheral Neuropathy-Evidence from Germany.

Patients with chronic peripheral neuropathy suffer greatly and their quality of life is often restricted. Drug therapy can be accompanied by undesirable side effects and intolerances, or the hoped-for effect does not materialize. Therefore, in addition to drug therapy, attempts are also made to treat the physical symptoms with complementary procedures. In the case of severe forms, the search for a suitable form of therapy is difficult. Complex treatments can be an innovative way to treat peripheral neuropathy. At the same time, several different therapy methods are carried out at high frequency by a specialized treatment team. This study aimed to provide an overview of possible complementary forms of therapy. The focus was on a comparison of two interdisciplinary complex therapies that are used in severe cases in an acute inpatient care setting in Germany. The six dimensions (energy, sleep, pain, physicality, emotional response and social isolation) of the Nottingham Health Profile (NHP) were used to assess quality of life. Both complex treatments (naturopathic complex therapy/multimodal pain therapy) showed a significant reduction in impairment in all dimensions of the NHP. In addition, a multivariate analysis was carried out to take into account several influencing variables at the same time. At the time of admission to the hospital, the degree of chronicity was recorded for each patient. This allowed statements to be made about the effect of the respective therapy depending on the chronification stage of the patient. It has been shown that patients with acutely exacerbated pain with the highest degree of chronicity also benefit from both complex treatments. The naturopathic complex treatment gives the treatment team more options. Aspects such as nutrition, methods from phytotherapy and traditional Chinese medicine can be integrated into inpatient care. Thus, a patient-centered, holistic therapy can take place. However, an interdisciplinary holistic therapy requires more time for both the practitioner and the patient. This should be taken into account in the health systems in the context of the diagnosis related groups.

Adoption Processes of Innovations in Health Systems: The Example of Telemedicine in Germany.

(1) Background: Individual adoption experiences represent important factors in implementing innovations. In the context of health systems, where the implementation of innovations aims to improve the quality of care, they provide an important basis for developing and adapting implementation strategies. (2) Methods: This study examines the adoption experiences of (tele-)medical experts (n = 13) using the example of telemedicine in the German healthcare system by means of a qualitative, guideline-based interview study. The interview guide, as well as the deductive-inductive analysis, is based on Rogers' adoption theory. The transcription and analysis process was carried out according to Kuckartz. (3) Results: A total of 304 interview statements could be coded and assigned to the five main categories of persuasion, knowledge, implementation, decision and confirmation. More than half of all statements were coded under the main category persuasion, with its subcategories of convictions regarding the implementation of telemedicine (n = 89), international comparison of Germany's development (n = 50), telemedicine as a way of optimizing resources (n = 22) and conviction to understand telemedicine as an overall system (n = 10). (4) Conclusions: This study provides insight into how the implementation of telemedicine in the German healthcare system is perceived by experts and allows for adjustments to the ongoing implementation strategy.

Community Health Nursing Education in Austria-The Need for Competences in Planning, Management and Collaboration: A Problem-Centered Qualitative Study.

(1) Background: The Austrian health care system is extremely fragmented. Primary care is mainly provided by self-employed GPs. Other health professionals are rarely integrated into primary care. But, according to the political plans of the Austrian government, a system of community nurses and community health nurses should be implemented and several pilot projects have already been started. (2) Objective: The present study explores the skills and competences needed in the planning, management and collaboration for the change in the system and gives recommendations for community health nurse education in Austria. (3) Methodology: Fifteen qualitative, problem-centered interviews were conducted with experts in the field of community health nursing and analyzed using qualitative content analysis. (4) Results: The skills and competences often and widely mentioned are interprofessional collaboration, cooperation with other actors, systems thinking, project and change management, and basic management skills, including strategic planning, communication, accounting and finance. Areas such as health planning and lobbying are also highlighted. The main competences are broken down into subcompetences, making it possible to create a detailed competence grid. Competences in planning, management and collaboration are particularly important in the initial stages of the first implementation of a community health nursing system. (5) Conclusions: Skills and competences in these areas occupy a central position. A multilayered breakdown of these competences is required in order to create a targeted requirements profile. Due to the small-scale fragmentation of the Austrian health care system, collaboration and coordination are more difficult and costly, but all the more important. The aforementioned skills and competences represent an essential expansion of nursing education in Austria.

Patient autonomy in cardiac inpatient rehabilitation-A COVID-19-specific exploratory trend study.

Background: The COVID-19 outbreak has changed nearly all societal domains, including medical rehabilitation. Social distancing measures impacted patients as well as health professionals during the rehabilitation process. Enhancing patient participation should not be forgotten during exceptional situations, as restrictive measures are related to the self-determination of patients. Aim: In this exploratory trend study, we aimed to examine the association between COVID-19 restrictions with patients' motivation, their perception of the patient-provider-relationship, their participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation. Methods: Adopting an exploratory approach, we compared data from a convenience sample of two different groups of patients, who stayed at a cardiac rehabilitation clinic at two different time periods: before the COVID-19 lockdown of rehabilitation clinics (n = 128) and after reopening during the COVID-19 period (n = 137). We used questionnaires on motivation for rehabilitation, patient-provider-relationship, patient activation and perceived state of health. We conducted t-tests and regression analysis to determine whether there were differences by gender, age, heart failure status, preferred form of decision-making (shared/not-shared) and time of rehabilitation (before/during COVID-19) related to the outcome variables. Results: Participants evaluated the quality of the patient-provider-relationship in a better way after the reopening of the rehabilitation clinics during the COVID-19 period (p < 0.05), their motivation, participation in the rehabilitation process and their current state of health at the beginning of their rehabilitation was comparable to the group before the COVID-19 lockdown of rehabilitation clinics. Differences in scepticism concerning the treatment and the quality of the patient-provider-relationship were related (p < 0.05) to age and the preferred form of decision-making. Differences in active participation were related (p < 0.05) to sex and differences in the perceived state of health (p < 0.05) to a heart failure diagnosis. Conclusions: Treatment providers could use the time patients spend in isolation after arrival to prepare them for virtual goal-setting conversations to enhance patient participation in exceptional situations.

Applied Change Management in Interventional Radiology-Implementation of Percutaneous Thermal Ablation as an Additional Therapeutic Method for Small Renal Masses.

Interventional radiology (IR) has the potential to offer minimally invasive therapy. With this potential, new and arising IR methods may sometimes be in competition with established therapies. To introduce new methods, transformational processes are necessary. In organizations, structured methods of change management, such as the eight-step process of Kotter-(1) Establishing a sense of urgency, (2) Creating the guiding coalition, (3) Developing a vision and strategy, (4) Communicating the change vision, (5) Empowering employees for broad-based action, (6) Generating short-term wins, (7) Consolidating gains and producing more change, and (8) Anchoring new approaches in the culture-are applied based on considerable evidence. In this article, the application of Kotter's model in the clinical context is shown through the structured transformational process of the organizational implementation of the percutaneous thermal ablation of small renal masses. This article is intended to familiarize readers in the medical field with the methods of structured transformational processes applicable to the clinical setting.

[Cardiovascular risk management in type-2 diabetes: Is the patients' cardiovascular risk adequately considered in type-2 specialist diabetes care?] / Kardiovaskuläres Risikomanagement bei Typ-2 Diabetes: Werden Menschen mit Typ-2 Diabetes in der diabetologischen Schwerpunktpraxis kardiovaskulär risikoadjustiert behandelt?

INTRODUCTION AND OBJECTIVES: More than 50% of the type-2 Diabetes (T2DM) mortality is due to cardiovascular disease. Current treatment guidelines recommend an increasingly differentiated and comprehensive management of cardiovascular risk factors. This study aims to measure the extent to which T2DM care is currently adjusted for cardiovascular risks in clinical practice. METHODS: This observational study included 123 T2DM patients of nine outpatient diabetology specialist clinics in Southern Germany. Guideline adherence was measured based on selected aspects of the joint guideline of the European Society of Cardiology (ESC) and the European Society for the Study of Diabetes (EASD). The proportion of patients with treatment target adherence, monitoring adherence, and therapy adherence for the areas of blood pressure and lipid metabolism management was determined, and the correlation between adherence and treatment outcome was assessed by comparing treatment target achievement rates between the group that received guideline-adherent care and the group with no guideline-adherent care. RESULTS: The combined adherence rates were 39% for blood pressure management and 10% for lipid management. 70% of the participants with adherent blood pressure management and 56% with non-adherent blood pressure management achieved the blood pressure target (p=0.165). 50% of the patients with guideline-adherent lipid management and 17% with not guideline-adherent lipid management achieved the LDL cholesterol target (p=0.032). DISCUSSION: Less than half of the study population received care that was adequately adjusted for cardiovascular risks. Participants that received risk-adjusted care achieved their treatment target for blood pressure and LDL cholesterol more often. In order to validate methods and results, the study should be repeated with routine care data from a larger study population. CONCLUSION: Guideline-adherent care pays off: cardiovascular risk-adjusted care, especially following the more differentiated ESC/EASC guideline 2019, increases the chance for T2DM patients to avoid or delay cardiovascular complications.

COVID-19 in Multimorbid Patients-A Controlled Microcost Description Analysis of Diagnosis Related Group (DRG)-Case Series in Acute Care without Non-Invasive Ventilation.

Diagnosis-related cost analyzes are important for health economic planning and decision-making. They form the basis for further developing of remuneration systems for health services. The rapid increase in hospital stays by COVID-19 patients requires a valid and exact calculation of the treatment costs. COVID-19 patients with many accompanying illnesses increase the requirements for a cost calculation. The focus of this work is to carry out a DRG-related micro-cost analysis, considering the age, length of stay and comorbidities of COVID-19 patients. So far, there is little information about treatment costs for multimorbid patients with COVID-19 who have not received invasive ventilation. The method is based on a standardized cost unit calculation for determining the treatment costs in a German hospital. The costs (€) of inpatients treated with COVID-19 were compared with a control group of the same DRGs of patients without COVID-19. The average total costs for inpatient treatment were €2866. The highest share of costs falls on nursing, personnel, and material costs of the non-medical infrastructure. Frequent comorbidities were heart failure, diabetes mellitus, other respiratory diseases, dizziness, and impairment of the musculoskeletal system.

Health Promotion as a Motivational Factor in Alpine Cycling.

The present study examines motives for cycling in the alpine region and focuses on the relative importance of health promotion with respect to other motives. Furthermore, the influences of person-specific characteristics on the rank of the motives are examined, and possibilities for advertising bike tourism based on these motives and characteristics are derived. By applying a quantitative approach, a total of 175 cyclists were surveyed using questionnaires on person-specific characteristics, motives, and their relevance for alpine cycling. Data analysis revealed that health promotion is the most important motive for alpine cycling after fun and action as well as nature experience. Further health-related motives such as stress reduction are also perceived as important. The social component, on the other hand, was given the least priority. The results also showed that person-specific characteristics influence the relative importance of motives. For example, elderly persons and people with children perceive the motive of health promotion as the most important. The study shows that the health-promoting effect of alpine cycling is noticed and may be further encouraged. This study demonstrates that alpine cyclists are a heterogeneous group and that health benefits are perceived by various sub-groups therein. Therefore, any marketing for alpine cycling needs to reflect the diversity of cyclists, and approaches need to be adapted according to the respective target group.

COVID-19 Patient with Severe Comorbidity in Multimodal Acute Care Setting with Non-Invasive Medical Ventilation: A Clinical Outcome Report.

The virus that causes COVID-19 is rapidly spreading across the globe. Elderly patients with multiple pre-existing conditions are at a higher risk. This case study describes acute inpatient treatment of a COVID-19 patient with uncontrolled diabetes mellitus, kidney complications, heart failure, chronic pain, depression, and other comorbidities in an isolation ward without mechanical ventilation.

Determinants of inpatient satisfaction: evidence from Switzerland.

PURPOSE: A common way to handle quality problems and increasing costs of modern health care systems is more transparency through public reporting. Thereby, patient satisfaction is seen as one main reported outcome. Previous studies proposed several associated factors. Only a few of them included organizational determinants with potential to inform the health care provider's management. Therefore, the aim of this study was to investigate the influence of organizational contingency factors on patient satisfaction. DESIGN/METHODOLOGY/APPROACH: As a case, Switzerland's inpatient rehabilitation sector was used. Therein, a cross-sectional study of public released secondary data with an exploratory multiple linear regression (MLR) modeling approach was conducted. FINDINGS: Five significant influencing factors on patient satisfaction were found. They declared 42.2% of the variance in satisfaction on provider level. The organizations' supplementary insured patients, staff payment, outpatients, extracantonal patients and permanent resident population revealed significant correlations with patient satisfaction. RESEARCH LIMITATIONS/IMPLICATIONS: Drawing on publicly available cross-sectional data, statistically no causality can be proved. However, integration of routine data and organization theory can be useful for further studies. PRACTICAL IMPLICATIONS: Regarding inpatient satisfaction, improvement levers for providers' managers are as follow: first, service provision should be customized to patients' needs, expectations and context; second, employees' salary should be adequate to prevent dissatisfaction; third, the main business should be prioritized to avoid frittering. ORIGINALITY/VALUE: Former studies regarding public reporting are often atheoretical and rarely used organizational variables as determinants for relevant outcomes. Therefore, uniformed data are useful.

Do Health Professionals Sufficiently Address Patients' Disposition Toward Changing Their Nutritional and Physical Activity Habits? Findings from a Pilot Study among People with Type 2 Diabetes in Northern Italy.

The aim of our study was to evaluate the disposition of individuals with type 2 diabetes mellitus (DM2) toward changing their nutritional and physical activity habits and associated factors-particularly their perceptions about interacting and communicating with four health professions. Working with a local patients' association, we invited 364 individuals with DM2, all at least 18 years old, to complete a paper-based survey with questions addressing their experiences of interacting and communicating with general practitioners, nurses, dieticians and diabetologists and about their readiness to change targeted habits, their health literacy and their clinical status. Of the 109 questionnaires collected, 100 were eligible for descriptive and inferential statistical analysis. Regarding nutritional habits, the highest percentage of participants were at the maintenance stage (26%), whereas regarding physical activity habits the highest percentage of participants were at the preparation stage (31%). Significant differences between the habits emerged for four of the five stages and for two psychological processes. The precontemplation stage was most associated with communication-related variables, whereas the maintenance stage was associated with higher health literacy for both habits, and waist-to-height ratio was associated with several stages of change and psychological processes for physical activity habits. Considering aggregated stages (i.e., active or passive stage), significant differences were observed for all psychological processes except readiness to change nutritional habits. Logistic regression analysis revealed associations of the active stage with higher self-efficacy and lower discrepancy processes for both habits. Nutritional habits were associated with normal HbA1c values and physical activity habits with high cholesterol. Understanding the combination of the stages of change and how they relate to psychological processes can afford meaningful insights into the potential internal and external communication skills of health professions and should be examined as possible elements for a patient evaluation model.

Living on the Own Island? Aligned Collaboration Between Family Physicians, Nurses, Dieticians, and Patients With Diabetes Type 2 in an Outpatient Care Setting in Northern Italy: Findings From a Qualitative Study.

INTRODUCTION: Diabetes mellitus type 2 (DM2), one of the four most important chronic diseases worldwide, is generally considered to be preventable. However, it is not yet sufficiently clear whether an aligned collaboration between different health professions could facilitate behavioral changes to be made by patients with DM2 regarding their eating and physical activity habits. OBJECTIVE: To explore if and how far in current outpatient care for 3 health-care professions it is an objective to collaborate with each other supporting patients with DM2 in changing their eating and physical activity habits. METHODS: We conducted 18 qualitative problem centered interviews with selected family physicians, nurses, dieticians working in outpatient setting and patients with DM2, transcribed verbatim, and analyzed with qualitative content analysis. RESULTS: Issues identified ranged from description and reflection of current health-care practice, strategies, and hindrances to cope with changes of eating and physical activity behaviors as well as for health-care practice regarding interprofessional collaboration and patient-centered care up to considerations about collaboration and patient centricity (for health professionals and patients to achieve goals) and changes and ideas of "ideal care practice". DISCUSSION: The included professional groups work predominantly for themselves. Collaboration currently only takes place when individually triggered and neither structured nor organized.

In guidelines physicians trust? Physician perspective on adherence to medical guidelines for type 2 diabetes mellitus.

AIMS: Adherence to treatment guidelines and treatment success are low in Type 2 diabetes mellitus (T2DM). This study aims to capture the physician perspective on T2DM guideline adherence and identify levers for increasing adherence. METHODS: A survey among German physicians captured the perceived value of 4 areas in the national treatment guideline (NVL), 13 possible barriers, and 9 possible enablers for guideline adherence. Perceived value was assessed by ranking 4 NVL areas by implementation difficulty and impact on treatment success. Barriers and enablers were assessed by rating their influence on guideline deviation and adherence. The consistency of results across subgroups was assessed using Fisher's exact test. RESULTS: Responses from 46 physicians showed a strong consensus about the value of each NVL area. Physicians perceived patient inability and demotivation to be the strongest adherence barriers (93%, 78%). All queried enablers were approved by ≥ 50% of participants. Physicians considered cross-provider collaboration and electronic therapy decision support as strongest enablers (85%, 80%). Consistency was high between subgroups. CONCLUSION: This study suggests that physicians consider patient-related factors to be stronger barriers for guideline adherence than physician-related factors. Finding opportunities to increase physician buy-in is important for better guideline adherence. In this study, physicians voiced appreciation for adherence enablers based on digital solutions to support the care process and to reduce the complexity of therapy decisions.

Patient-Reported Outcomes Following Inpatient Multimodal Treatment Approach in Chronic Pain-Related Rheumatic Diseases.

INTRODUCTION: Musculoskeletal disorders may cause chronic pain, which is associated with deterioration in physical well-being, functions, and quality of life. There are worldwide shortfalls in the care that is provided to the affected patients. Holistic, interdisciplinary care is rare. Monomodal therapeutic approaches dominate when health-care resources are scarce. In this study, we test the patient-relevant outcomes of multimodal treatment for rheumatic diseases that are associated with pain and check for remuneration. METHODS: We performed a retrospective data analysis of an inpatient multimodal treatment. The target parameter was the patient perspective, which we assessed by means of Patient-Reported Outcomes (PRO). We applied the Visual Analogue Scale (mental and physical condition), the Heidelberg Short Early Risk Assessment Questionnaire, the Pain Disability Index, and the pain grading according to Kohlmann/Raspe (N = 375 patients). We also investigated compensation for inpatient treatments with and without multimodal treatments. Moreover, we compared Diagnosis-Related Group remuneration with and without complex treatment. RESULTS: After implementing a multimodal treatment, improved mental (mood) status was significantly better (Wilcoxon signed-rank test, P < . 001), despite high levels of pain (Kohlmann/Raspe) reported on admission. Apart from the underlying rheumatic disease, 111 patients also reported chronic back pain, which was improved following the treatment (t test, P < . 001). Subjective impairments associated with pain were significantly lower at the end of the hospital stay (Wilcoxon signed-rank test, P < . 001). Compensation for inpatient treatments with multimodal treatments increased noticeably in German hospitals in 2016 to 2019, while remunerations for monomodal treatments show mixed results. CONCLUSION: PROs regarding mood, pain, and perceived impairments improved following the multimodal complex treatment. Compensation of hospitals should take into account additional performance requirements of holistic treatments, whereby the promotion and further studies of PROs are recommended.

Long-Term Impact of Disasters on the Public Health System: A Multi-Case Analysis.

As past events have shown, disasters can have a tremendous impact on the affected population's health. However, research regarding the long-term impact on a systems level perspective is still scarce. In this multi-case study, we analyzed and compared the long-term impacts on the public health system of five disasters which took place in Europe: avalanche (Austria), terror attack (Spain), airplane crash (Luxembourg), cable-car tunnel fire (Austria), and a flood in Central Europe. We used a mixed-methods approach consisting of a document analysis and interviews with key stakeholders, to examine the various long-term impacts each of the disasters had on health-system performance, as well as on security and health protection. The results show manifold changes undertaken in the fields of psychosocial support, infrastructure, and contingency and preparedness planning. The holistic approach of this study shows the importance of analyzing long-term impacts from the perspective of the type (e.g., disasters associated with natural hazards) and characteristic (e.g., duration and extent) of a disaster, as well as the regional context where a disaster took place. However, the identified recurring themes demonstrate the opportunity of learning from case studies in order to customize the lessons and apply them to the own-disaster-management setting.

COVID-19 Case Report: An 84-Year-Old Man with Exacerbation of Multiple Comorbidities Due to COVID-19 Managed by a Multidisciplinary Team Using Patient-Reported Outcomes.

BACKGROUND When treating patients with comorbidities who are infected with severe acute respiratory syndrome as a result of SARS-CoV-2, it is crucial to offer multidisciplinary treatment that takes into consideration all of the health conditions with which they have been diagnosed. In particular, clinicians should not lose sight of the patient experience, which we can be assessed with the help of patient-reported outcomes (PROs). CASE REPORT An 84-year-old man infected with SARS-CoV-2 was already suffering from multiple health conditions, including Type 2 diabetes mellitus. He most likely was receiving cortisone therapy and had chronic pain with spondylosis with radiculopathy, bilateral gonarthrosis following total knee replacement, malaise, and fatigue. The patient received acute inpatient care in a hospital that provides complementary medical therapies. We collected clinical and patient-reported data on quality of life, physical functions, the sensation of pain, psychological well-being, and symptoms while taking into account the degree of chronicity of the conditions, the level of the patient's pain, and his hospitalization in an isolation ward. We stabilized clinical parameters related to the patient's main underlying health conditions (blood glucose and pain levels and oxygen saturation). The PROs we collected demonstrated a significant improvement on discharge. CONCLUSIONS Applying PROs can be helpful in obtaining a more comprehensive picture of a patient with COVID-19, in which "the patient is given a voice," in addition to being assessed by others. The knowledge gained can then be made available to the interdisciplinary treatment team to be incorporated into the treatment plan.

Nature Relatedness of Recreational Horseback Riders and Its Association with Mood and Wellbeing.

Connectedness to nature and nature contact can provide many benefits to humans, like stress reduction, recovery from illness, and increased positive emotions. Likewise, recreational horseback riding is a widespread sports activity with the potential to enhance physical and psychological health. Yet, the influence of connectedness to nature on the wellbeing of older aged recreational horseback riders has not been investigated so far. The aim of the present study therefore was to explore the relationship between nature relatedness and physical, psychological and social wellbeing and happiness. The study sample was composed of Austrian recreational horseback riders aged 45 years and older, who were compared with dog owners and people without pets (n = 178). We found significantly higher nature relatedness, significantly higher overall wellbeing and a significantly better mood rating in recreational horseback riders compared to people without pets and similar scores compared to dog owners. Physical wellbeing is correlated with overall nature relatedness in horseback riders and dog owners, but no correlation was found in people without pets. A structural equation model shows a direct relationship between nature relatedness and mood in horseback riders and an indirect relationship through pet attachment in dog owners. The results suggest the activity with horses and dogs in nature environments is a source of wellbeing, enjoyment, self-confidence and social contacts.

The weekend effect revisited: evidence from the Upper Austrian stroke registry.

Empirical evidence on the so-called 'weekend-effect' on stroke mortality is mixed with some studies reporting significantly higher mortality for weekend admissions and others finding no difference. The aim of this paper is to enhance the evidence on the weekend-effect on stroke mortality using a rich stroke registry data set from Upper Austria and to discuss underlying reasons for the heterogeneity in results. Using logistic regressions and ordinary least squares regressions with hospital and year-fixed effects, the outcomes of weekend versus weekday admissions are compared for patients admitted to 16 hospitals in Upper Austria with transient ischemic attack (TIA), cerebral infarction or hemorrhage between 2007 and 2015. The primary outcomes include in-hospital mortality, 30-day and 90-day all-cause mortality as well as the length of hospital stay. In addition, we analyze differences in process-quality indicators between weekdays and weekends. Our results show that on weekends there are on average 25% fewer admissions than on weekdays with significantly higher in-hospital mortality. Adjusting for case-mix, the association between weekend admissions and mortality becomes null suggesting that the higher mortality on weekends is explained by heterogeneities in admissions rather than health-care quality.

Job-related meaningfulness moderates the association between over-commitment and emotional exhaustion in nurses.

AIM: To evaluate characteristics of job-related meaningfulness, and to assess its potential to moderate the relationship between over-commitment and emotional exhaustion in nurses. BACKGROUND: Increased demands on nurses may induce vulnerability to emotional exhaustion, decrease job satisfaction, and increase their intention to quit the job. The experience of job-related meaningfulness through meaning-centred logotherapy and counseling could be a resource to prevent emotional exhaustion. METHOD: Nurses (n = 466; 73% female) at an Austrian tertiary-care hospital participated in a cross-sectional survey for assessment of job-related meaningfulness by the newly developed CERES (Concern, Enthusiasm, Relevance, Efficacy, Satisfaction) scale. CERES was tested for its moderating interaction with over-commitment (assessed by the Effort-Reward Imbalance Questionnaire) to prevent emotional exhaustion (as measured by the Maslach Burnout Inventory) by structural equation modelling. RESULTS: The CERES scale consisting of five items has satisfactory internal consistency (Cronbach's alpha: .78). Over-commitment correlated significantly (p < .001) with emotional exhaustion. A moderating interaction of CERES with over-commitment on emotional exhaustion was found overall (p < .001), and separately for males (p = .002) and females (p < .001). CONCLUSIONS: CERES is suitable for assessing experienced job-related meaningfulness and it moderates emotionally exhausting effects of over-commitment in nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers may improve nurses' awareness of job-related meaningfulness by focusing on meaning-centred feed-back and counselling and thereby strengthening perception of concern, enthusiasm, relevance, efficacy, and satisfaction regarding their caring behaviour.

Interdisciplinary assessment-oriented treatment of fibromyalgia: a case report.

Patients with fibromyalgia (FM) have often tried many outpatient treatments, and breakthrough pain frequently stops them from performing everyday tasks and participating in society. FM-pain that has become chronic, therefore, affects quality of life. This case study describes the administration of interdisciplinary inpatient pain therapy due to a primary diagnosis of fibromyalgia with integrated complementary medicine. The female patient, who had several concomitant disorders and had been suffering from pain for many years, benefited from the holistic treatment approach in terms of a reduction in pain and an improvement in physical functions and mental health. The ability to have a positive effect on pain symptoms in the longer term is essential. Compliance with the treatments used should also be improved, so that a healthier lifestyle and better pain management can continue after discharge from hospital. These results are supported by other study results and should provide the impetus for major studies to evaluate holistic pain therapies in FM.