[Health companion : Findings from the testing of a new volunteering profile]. / Gesundheitsbegleitung : Erkenntnisse aus der Erprobung eines neuen Engagementprofils.

BACKGROUND: For many (older) people, especially those with chronic diseases, it is a challenge to maintain or develop a health-promoting lifestyle. Knowledge and possibilities of organizing one's own everyday life accordingly are distributed in a socially unequal way; loss of mobility and lack of support and a diluted supply structure in rural areas are further obstacles. As part of the development of a model health center in a rural neighborhood, an approach to health support based on voluntary work was developed and tested, in which volunteers (n = 10) were appointed as peers. OBJECTIVE: This article describes the theoretical embedding, the conceptual framework of the training (participative learning) and the volunteering profile (outreach support) as well as the effects achieved. On the basis of project experiences and selected evaluation results both beneficial factors as well as challenges were identified. These have to be considered in the further development of the volunteering profile and its implementation in the practice. MATERIAL AND METHODS: For the evaluation a mixed methods design was applied at two measurement points. In the surveys 14 accompanied persons were included. The qualitative data were analyzed by qualitative content analysis according to Mayring and the quantitative data by descriptive statistics. RESULTS: The results show that chronically ill (older) people are reached by the voluntary health companion (eGb). The outreach support has positive effects on the receivers and leads to concrete changes in behavior. CONCLUSION: For the further development, dissemination and consolidation of the eGb, various challenges need to be addressed and adjustments are necessary.

["Puppet accompaniment"-A geragogically based accompaniment approach]. / "PuppetBegleitung" ­ ein geragogisch fundierter Begleitungsansatz.

BACKGROUND: Home care for older people with dementia (PwD) is associated with special needs and requires appropriate support services as well as learning and developmental impulses from a geragogical perspective. The accompanied use of robotic technology can be a suitable approach. OBJECTIVE: In the Federal Ministry for Education and Research (BMBF)-funded research and development (R and D) project "OurPuppet" (2016-2019), an accompaniment profile was to be developed and tested in order to introduce a technical intervention (sensor-based robotic system in form of a puppet) into the home care of PwD. The aim was to stimulate technology learning, to motivate the use of technology and to contribute to the stability of the care situation. MATERIAL AND METHODS: A partially standardized and qualitative evaluation of the concept in the preparation course for the accompaniment profile and a qualitative in-process evaluation of the accompaniment approach in an explorative practical test over several months within five families took place. RESULTS AND CONCLUSION: The puppet accompaniment approach, which was developed, tested and evaluated in the R and D project "OurPuppet" is presented. The participatory curriculum development and self-determined learning can be seen as success factors for the appropriation processes. The accompanied introduction of techniques has proven to be profitable. The added value experienced by the users goes far beyond a user-oriented technology design. The feasibility and acceptance of the technology and support approach in the context of home care of PwD has been proven. For further development, sustainable structures have been created with the establishment of the Network Center for Engagement, Support and Accompaniment at the "Hochschule für Gesundheit Bochum" (hsg).

A Network-Wide Stroke Team Program Reduces Time to Treatment for Endovascular Stroke Therapy in a Regional Stroke-Network.

BACKGROUND AND PURPOSE: Driven by the positive results of randomized, controlled trials of endovascular stroke therapies (EVT) in stroke patients with large vessel occlusion, different approaches to speed up the workflow for EVT candidates are currently being implemented worldwide. We aimed to assess the effect of a simple stroke network-wide workflow improvement project, primarily focusing on i.v. thrombolysis, on process times for patients undergoing EVT. METHODS: In 2015, we conducted a network-wide, peer-to-peer acute stroke workflow improvement program for i.v. thrombolysis with the main components of implementing a binding team-based algorithm at every stroke unit of the regional network, educating all stroke teams about non-technical skills and providing a stroke-specific simulation training. Before and after the intervention we recorded periprocedural process times, including patients undergoing EVT at the 3 EVT-capable centers (January - June 2015, n = 80 vs. July 2015 - June 2016, n = 184). RESULTS: In this multi-centric evaluation of 268 patients receiving EVT, we observed a relevant shortening of the median time from symptom onset to EVT specifically in patients requiring secondary transfer by almost an hour (300 min, 25-75% interquartile range [IQR] 231-381 min to 254 min, IQR 215.25-341 min; p = 0.117), including a reduction of the median door-to-groin time at the EVT-capable center in this patient group by 15.5 min (59 min, IQR 35-102 min to 43.5 min, IQR 27.75-81.25 min; p = 0.063). In patients directly admitted to an EVT-capable center, the median door-to-groin interval was reduced by 10.5 min (125 min, IQR 83.5-170.5 min to 114.5 min, IQR 66.5-151 min; p = 0.167), but a considerable heterogeneity between the centers was observed (p < 0.001). CONCLUSIONS: We show that a simple network-wide workflow improvement program primarily directed at fast i.v. thrombolysis also accelerates process times for EVT candidates and is a promising measure to improve the performance of an entire stroke network.

[OurPuppet - Caring support with an interactive puppet for informal caregivers : Opportunities and challenges in the social and technical developmental process]. / OurPuppet ­ Pflegeunterstützung mit einer interaktiven Puppe für pflegende Angehörige : Chancen und Herausforderungen im sozialen und technischen Entwicklungsprozess.

BACKGROUND: The "OurPuppet" project comprises a sensor-based, interactive puppet that will be developed to communicate with people in need of care during a short period of absence of the informal caregiver. Specially qualified puppet guides will support the use of the new technical development. They instruct people with dementia and caregivers on how to use the puppet and supervise the (informal) care relationship through discussions on a regular basis. OBJECTIVES: The article shows the specific components of users' needs for which the concrete technical development should find answers. It also focuses on the opportunities and challenges for the technical and social developmental process accompanied by these demands. MATERIAL AND METHODS: The analysis of the users' needs is based on a participatory approach. Semi-structured focus group interviews were conducted with informal caregivers, nurses and volunteers in order to identify typical situations in home care settings. The interviews were paraphrased and summarized in order to deduce inductive categories (qualitative data analysis), which describe everyday situations that the technical system should address. RESULTS AND CONCLUSION: Such analyses provide information about the needs of potential users and indicate how to design such technical systems. Furthermore, opportunities and challenges of the development process as well as important contextual information were identified.

Implementation of stroke teams and simulation training shortened process times in a regional stroke network-A network-wide prospective trial.

BACKGROUND: To meet the requirements imposed by the time-dependency of acute stroke therapies, it is necessary 1) to initiate structural and cultural changes in the breadth of stroke-ready hospitals and 2) to find new ways to train the personnel treating patients with acute stroke. We aimed to implement and validate a composite intervention of a stroke team algorithm and simulation-based stroke team training as an effective quality initiative in our regional interdisciplinary neurovascular network consisting of 7 stroke units. METHODS: We recorded door-to-needle times of all consecutive stroke patients receiving thrombolysis at seven stroke units for 3 months before and after a 2 month intervention which included setting up a team-based stroke workflow at each stroke unit, a train-the-trainer seminar for stroke team simulation training and a stroke team simulation training session at each hospital as well as a recommendation to take up regular stroke team trainings. RESULTS: The intervention reduced the network-wide median door-to-needle time by 12 minutes from 43,0 (IQR 29,8-60,0, n = 122) to 31,0 (IQR 24,0-42,0, n = 112) minutes (p < 0.001) and substantially increased the share of patients receiving thrombolysis within 30 minutes of hospital arrival from 41.5% to 59.6% (p < 0.001). Stroke team training participants stated a significant increase in knowledge on the topic of acute stroke care and in the perception of patient safety. The overall course concept was regarded as highly useful by most participants from different professional backgrounds. CONCLUSIONS: The composite intervention of a binding team-based algorithm and stroke team simulation training showed to be well-transferable in our regional stroke network. We provide suggestions and materials for similar campaigns in other stroke networks.

Morphometric differences in central stress-regulating structures between women with and without borderline personality disorder.

BACKGROUND: Experiences of early life stress, increased psychological arousal and the body's physiologic stress response seem to play an important role in the pathogenesis and maintenance of borderline personality disorder (BPD). In the present study, we investigated alterations in grey matter of central stress-regulating structures in female patients with BPD. METHODS: We examined T1-weighted structural magnetic resonance imaging scans of unmedicated, right-handed female patients with BPD (according to DSM-IV criteria) and healthy controls matched for age, intelligence and education using fully automated DARTEL voxel-based morphometry. Our regions of interest analyses included the hippocampus, amygdala, anterior cingulate cortex (ACC) and hypothalamus. RESULTS: We enrolled 30 patients and 33 controls in our study. The grey matter of patients with BPD was reduced in the hippocampus, but increased in the hypothalamus compared with healthy participants. Hypothalamic volume correlated positively with the history of traumatization in patients with BPD. No significant alterations were found in the amygdala and ACC. LIMITATIONS: This study is limited by the lack of measures of corticotropin-releasing hormone, adrenocorticotropic hormone and cortisol levels. Furthermore, moderate sample size and comorbid disorders need to be considered. CONCLUSION: Our findings provide new evidence for grey matter alterations in the hypothalamus and replicate previously reported decrements in hippocampal volume in patients with BPD. Understanding the role of the hypothalamus and other central stress-regulating structures could help us to further understand the neurobiological underpinnings of this complex disorder.