World views on shortage in nursing resource: Challenges and opportunities.

BACKGROUND: Shortage in nursing resource results from the combination of a lack of nurses, an increased patient volume and workload, and other factors. This seems to be a worldwide phenomenon, leading to multiple health care related challenges and a decreased quality of care, but is different in extent in high- vs. low-income countries. An international perspective can alleviate challenges to keep our patients safe through increasing our health workers' safety. PURPOSE & METHOD: To exchange experiences with the shortage in nursing resource globally, an international online conference event was hosted. Speakers from Germany, the Philippines, Poland, Tanzania, the United Kingdom and the United States presented their national challenges and strategies to deal with this phenomenon. RESULTS: Conference presentations included information about the health care systems, comparable numbers of hospital beds, nurses, and nursing education. Speakers reported challenges such as an imbalance between a high nurse vacancy rate and demands, but also war and refugees, high human immunodeficiency virus (HIV) and other infection rates, or nurses' migration to other countries; the solutions reported included buy-in from other countries, nurses-attracting projects such as Magnet hospitals, improved job opportunities like higher wages, career prospects, or improved education, and others. CONCLUSIONS: Shortage in nursing resource seems to be a global phenomenon. Nursing managers and researchers should exchange and communicate challenges and solutions continuously and cooperate globally.

[The population perspective in assessing the performance of Germany's health care system: Results of a cross-sectional survey among members of a statutory health insurance]. / Die Bevölkerungsperspektive in der Bewertung der Leistungsfähigkeit des deutschen Gesundheitssystems: Ergebnisse einer Querschnittsbefragung GKV-Versicherter.

INTRODUCTION: Since the World Health Report in 2000, Health System Performance Assessment (HSPA) has been established as a tool for the evaluation and evidence-informed governance of health systems. So far, the population perspective has not been integrated into HSPA in a systematic manner, although people's experiences and expectations are of great importance to improve health systems and especially to strengthen patient-centered care. Therefore, this study aims to conduct an HSPA of Germany's health system from the population's perspective covering all eight goals of WHO's Health Systems Framework, and to identify strengths and needs for improvement. METHODS: In 2018, 32,000 people insured with the German sickness fund 'AOK Nordost' were invited by mail to participate in the survey. The questionnaire contained a total of 43 items covering the eight goals of WHO's Health Systems Framework (e.g., access, quality, safety) plus socioeconomics and other characteristics of the insured persons. The data on the health system goals were analyzed descriptively and by subgroups (age, sex, income, chronic conditions, health literacy). RESULTS: The sample (n=1,481; response rate 4.6%) was 54.8% female and had a mean age of 59.1 years (±18.5). Altogether, the participants saw several needs for improvement within the German health system. For instance, 60.0% found quality differences between hospitals to be big, and between 3.9% and 8.5% reported mistakes related to their treatment or prescription medication in the previous two years. A big need for reform was especially seen regarding out-of-pocket payments (51.5%) and the coordination of ambulatory care physicians among each other (44.2%) and with hospitals (41.9%). In addition, big subgroup differences were seen, especially for income and health literacy. Of the participants in the lower income group, 37.2% reported a (very) strong financial burden due to out-of-pocket payments (vs. 20.7%). People with limited health literacy (52.1%) assessed the access to care generally as not being good, and they perceived greater quality differences and needs for reform, compared to their counterparts. For instance, 36.6% had experienced discrimination in the previous year (vs. 19.9%). DISCUSSION: The survey results provide a comprehensive picture of Germany's health system from the population perspective. In some areas, previous findings were confirmed (e.g., a lack of coordination between providers). Other results expand existing knowledge (e.g., the role of health literacy in health care provision) or raise new questions (e.g., the difference between the subjectively assessed burden from out-of-pocket payments and the objective measures currently used). The great differences between subgroups are a call to action on the level of both politics and practice to better consider the individual's needs in order to make health better for everyone. Further research could provide deeper insights in this regard. CONCLUSION: Strengthening the population perspective in HSPA allows for a better understanding and evaluation of health systems and, in particular, helps to identify areas for improvement in patient-centered care.

Underfunding of German university-based high-performance medicine exemplified by the treatment of varices in cirrhosis.

Facing increasing economization in the health care sector, clinicians have to adapt not only to the ever-growing economic challenges, but also to a patient-oriented health care. Treatment costs are the most important variable for optimizing success when facing scarce human resources, increasing material- and infrastructure costs in general, as well as low revenue flexibility due to flat rates per case in Germany, the so-called Diagnosis-Related Groups (DRG). University hospitals treat many patients with particularly serious illnesses. Therefore, their share of complex and expensive treatments, such as liver cirrhosis, is significantly higher. The resulting costs are not adequately reflected in the DRG flat rate per case, which is based on an average calculation across all hospitals, which increases this economic pressure. Thus, the aim of this manuscript is to review cost and revenue structures of the management of varices in patients with cirrhosis at a university center with a focus on hepatology. For this monocentric study, the data of 851 patients, treated at the Gastroenterology Department of a University Hospital between 2016 and 2020, were evaluated retrospectively and anonymously. Medical services (e.g., endoscopy, radiology, laboratory diagnostics) were analyzed within the framework of activity-based-costing. As part of the cost unit accounting, the individual steps of the treatment pathways of the 851 patients were monetarily evaluated with corresponding applicable service catalogs and compared with the revenue shares of the cost center and cost element matrix of the German (G-) DRG system. This study examines whether university-based high-performance medicine is efficient and cost-covering within the framework of the G-DRG system. We demonstrate a dramatic underfunding of the management of varicose veins in cirrhosis in our university center. It is therefore generally questionable whether and to what extent an adequate care for this patient collective is reflected in the G-DRG system.

How do maternal and child health nurses incorporate infant mental health promotion into their clinical practice? Experiences of an Australian municipality.

The field of infant mental health (IMH) has offered valuable insights into the critical importance of social-emotional development, including the enduring influence of early experiences throughout life. Maternal and Child Health (MCH) nurses are ideally placed to facilitate knowledge sharing with parents. This Australian-based qualitative exploratory descriptive study explored how MCH nurses incorporate IMH in their clinical practice, and how they share this information with caregivers. Ten community-based MCH nurses participated in voluntary, semi-structured interviews which were transcribed verbatim and analyzed thematically. Findings identified five themes that characterized how MCH nurses incorporated IMH concepts into their practice. These themes were: prioritizing physical health promotion activities, highlighting infant communications, variations in knowledge and application of IMH concepts, workplace time schedules, and the relational nature of the work. Recommendations include encouraging IMH as a health promotion activity, facilitating IMH assessment, further education, reflective supervision, and extension of predetermined appointment times to enable knowledge and skill sharing. Further research is also recommended to provide additional insights into how nurses with IMH training promote and share IMH concepts with caregivers. Adoption of these recommendations would further enhance the care given to families and the role of the MCH nurses.

El campo de la salud mental infantil (IMH) ha ofrecido perspectivas valiosas sobre la suma importancia del desarrollo socioemocional en los primeros años para el desarrollo social y emocional posterior. Las enfermeras de la salud materno-infantil (MCH) se encuentran en posición ideal para facilitar el proceso de compartir conocimiento con los progenitores. Este estudio cualitativo, exploratorio y descriptivo, llevado a cabo en Australia, exploró cómo las enfermeras MCH incorporan IMH en sus prácticas clínicas y cómo ellas comparten esta información con los cuidadores. Un grupo de enfermeras MCH de base comunitaria participó en entrevistas voluntarias semiestructuradas. Las entrevistas se transcribieron palabra por palabra y se analizaron temáticamente. Los resultados identificaron cinco temas que caracterizaban cómo incorporaron los conceptos de IMH en su práctica. Estos temas fueron: actividades para promover el darle prioridad a la salud física, enfatizar las comunicaciones del infante, variaciones en el conocimiento y la aplicación de conceptos de IMH, tablas de horarios del lugar de trabajo y la naturaleza relacional del trabajo. Entre las recomendaciones se incluyen el fomentar IMH como una actividad de promoción de la salud, facilitar la evaluación de IMH, más educación, supervisión con reflexión, así como extensión del horario de citas predeterminado para permitir el proceso de compartir conocimiento y habilidades. También se recomienda más investigación para ofrecer perspectivas adicionales de cómo las enfermeras con entrenamiento de IMH promueven y comparten los conceptos de IMH con los cuidadores. La adopción de estas recomendaciones mejoraría más el cuidado que se ofrece a familias y el papel de las enfermeras MCH.

Le domaine de la santé mentale du nourrisson (IMH en anglais) a permis de mieux comprendre l'importance critique du développement socio-émotionnel dans les premières années pour le développement social et émotionnel ultérieur. Les infirmiers et infirmières de la Santé Maternelle et de l'Enfant (MCH en anglais) sont idéalement situées pour faciliter le partage des connaissances avec les parents. Cette étude Qualitative Exploratoire Descriptive, en Australie, a exploré comment les infirmier/infirmières MCH incorporent l'IMH dans leur pratique clinique et comment ils/elles partagent cette information avec les personnes prenant soin des enfants. Une cohorte de 10 infirmiers/infirmières MCH basées dans leur communauté ont participé à des entretiens volontaires semi-structurés. Les entretiens ont été transcrits verbatim et analysé de manière thématique. Les résultats ont identifié cinq thèmes qui ont caractérisé les concepts IMH dans leur pratique. Ces thèmes étaient: donner la priorité à la promotion d'activités de santé physique, la mise en évidence des communications du nourrisson, les variations dans les connaissances et l'application des concepts IMH, les emplois du temps du lieu de travail et la nature relationnelle du travail. Les recommandations incluent la nécessité d'encourager l'IMH en tant qu'activité de promotion de la santé, la facilitation de l'évaluation IMH, une formation supplémentaire, une supervision de réflexion et l'extension de rendez-vous pour développer les connaissances et partager les compétences. De plus amples recherches sont recommandées afin d'éclairer la manière dont les infirmiers/infirmières formées en IMH promeuvent et partagent les concepts IMH avec les personnes prenant soin des enfants. L'adoption de ces recommandations pour améliorer davantage le soin offert aux familles et les rôles des infirmiers/infirmières MCH.

[Participation in primary care research - From the idea to the constitution of a citizens advisory board]. / Partizipation in der allgemeinmedizinischen Forschung ­ Von der Idee bis zur Gründung eines Bürger*innenbeirats.

INTRODUCTION: Public participation in research processes is becoming increasingly important and is justified with positive effects for research. The first successful initiatives can also be found in general practice and health services research. The transparent presentation of these projects is essential to the discussion about participation. The aim of this article is to present and discuss the conception and implementation of the initiative at the Institute of General Practice and Health Services Research at the Technical University of Munich and the kick-off event for the participation of patients, citizens and patient representatives. METHODS: This article reports the planning, recruitment, implementation, and evaluation of the kick-off event. Frameworks for future events are described. RESULTS: In total, twelve persons were recruited through various recruitment channels to participate in the kick-off event. The participants showed a diverse structure of motives with regard to participation in research. All participants shared the essential goal of improving research and care by adding their perspectives to research processes. However, the specific opportunities for participation and the role of patients and citizens in research processes were unclear. During the event, future workshops were planned to address these challenges. The focus was on strengthening relationships and communicating the basics of primary care research in order to enable sustainable participation. DISCUSSION: The participants' different motivations resulted in the need to explore the concrete possibilities of participation. One of the specific requirements was to focus on role identification and the structure of the initiative. The question of self-description and -identification as a patient and/or citizen seemed crucial. Furthermore, a concise introduction to the topic of participation in research processes, as well as patient and citizen qualifications, is considered necessary. CONCLUSION: Establishing an advisory board for patients and citizens in primary care research is associated with specific requirements. In addition to fundamental necessities such as the joint clarification of the possibilities of participation, defining the role and establishing the identity of the initiative should be promoted.

[Implementing systematically: To what extent can implementation science make an educational contribution to health care practice?] / Systematisch implementieren. Inwiefern kann die Implementierungswissenschaft einen Bildungsbeitrag für die Akteure im Gesundheitswesen leisten?

BACKGROUND: Implementation science is currently struggling with the challenge to translate its findings into implementation practice in health care. Therefore, it is of interest to explore to what extent advanced trainings are relevant for health care practice to support knowledge circulation, and what needs to be considered in their design. DESIGN OF EDUCATIONAL INITIATIVES AND TRAINING: Internationally, numerous initiatives have emerged in recent years to make implementation science more accessible to health care implementers. They focus, in particular, on the development of curricula for actors in health care practice and the widespread implementation of these qualification programs. In German-speaking countries, the interest in health services research is particularly evident at the level of Master's degree programs to make implementation science accessible to health care. However, these efforts need to be complemented by a participatory, needs-oriented and theory-based approach to advanced training for implementers in health care practice. This will enable the required competencies to be addressed on different levels of training and the further development of training formats. DISCUSSION: Recent literature shows that implementers in German-speaking countries can benefit from a training program tailored to their needs. International experience in the field of advanced training in implementation science for health care practice allows us to derive essential components for the development of advanced training for the German-speaking region.

Will I love my second baby as much as my first? Prevalence and psychosocial correlates of maternal-fetal relationship anxiety for second-time mothers.

Most mothers have more than one child. Second-time mothers may worry about whether they will love the second baby as much as their first child. The current study examined mothers' maternal-fetal relationship anxiety (MFRA) to their second baby, the prediction of mother-infant bonding (MIB) and infant-mother attachment security post-partum, and the psychosocial correlates of mothers' MFRA during pregnancy. Mothers (N = 241, 85.9% White, 5.4% Black, 2.9% Asian/American, 3.7% Latina) and their second-born infants (55% boys) living in the Midwestern United States participated in a longitudinal investigation starting in the last trimester of pregnancy, and 1, 4, 8, and 12 months postpartum. Most women reported little to no anxiety about forming an attachment to their second baby (89.1%). MFRA predicted less maternal warmth toward the baby at 1, 4, and 8 months postpartum, but did not predict security of the infant-mother attachment at 12 months. Prenatal MFRA was also related to maternal depressive symptoms, an insecure attachment with the first child, more marital distress, and more adult attachment avoidance and ambivalence prenatally. Mothers worrying about loving a second baby as much as their first child may be experiencing other psychosocial risks that have repercussions for the developing mother-infant relationship.

La mayoría de las madres tiene más de un niño. Las que son madres por segunda vez se preocupan de si ellas amarán al segundo bebé tanto como al primer niño. El presente estudio examinó la ansiedad de la relación materno-fetal (MFRA) con su segundo bebé, la predicción del apego madre-infante y la seguridad de la afectividad madre-infante posterior al parto, así como las correlaciones sicosociales de la MFRA de las madres durante el embarazo. Las madres (N = 241, 85.9% blancas, 5.4% negras, 2.9 asiático-americanas, 3.7% latinas) y sus segundos infantes (55% varones), quienes vivían en el medio-oeste de los Estados Unidos, participaron en una investigación longitudinal comenzando en el último trimestre del embarazo, y a 1, 4, 8 y 12 meses después del parto. La mayoría de las mujeres reportó entre poca y ninguna ansiedad acerca de formar una relación afectiva con su segundo bebé (89.1%). La MFRA predijo menos calidez materna hacia el bebé a 1, 4 y 8 meses después del parto, pero no predijo la seguridad de la afectividad madre-infante a los 12 meses. La MFRA prenatal también se relacionó con los síntomas depresivos maternos, una afectividad insegura con el primer niño, más angustia marital, así como un mayor sentido adulto de ambivalencia y de evitar la afectividad prenatalmente. Las madres que se preocupan acerca de querer a su segundo bebé tanto como a su primer niño pudieran experimentar otros riesgos sicológicos y tener repercusiones para el desarrollo de la relación madre-infante.

La plupart des mères ont plus d'un seul enfant. Les mères pour la deuxième fois peuvent s'inquiéter si elles aimeront le second bébé autant que leur premier enfant. Cette étude a examiné l'anxiété de la relation maternelle-fœtale (abrégé MFRA selon l'anglais) des mères en lien à leur second bébé, la prédiction du lien mère-nourrisson et la sécurité de l'attachement nourrisson-mère postpartum ainsi que les corrélats psychosociaux de la MFRA des mères durant la grossesse. Les mères (N = 241, 85,9% blanches, 5,4% noires, 2,9% asiatiques américaines, 3,7% latinas) et leur deuxième bébé (55% de garçons) vivant dans le centre nord des Etats-Unis d'Amérique ont participé à une enquête longitudinale commençant le dernier trimestre de la grossesse et à 1, 4, 8 et 12 mois postpartum. La plupart des femmes ont fait état de presque aucune anxiété quant à la formation de l'attachement à leur second bébé (89,1%). La MFRA a prédit moins de chaleur maternelle envers le bébé à 1, 4, et 8 mois postpartum mais n'a pas prédit la sécurité de l'attachement bébé-mère à 12 mois. La MFRA prénatale était aussi liée aux symptômes dépressifs maternels, à un attachement insécure avec le premier enfant, à plus de détresse conjugale et à plus d'évitement et d'ambivalence de l'attachement adulte avant la naissance.

[Qualitätsstandards in der Alterspsychiatrie]. / Standards de qualité en psychiatrie de la personne âgée.

Quality Standards in Old Age Psychiatry Abstract: Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

Résumé: Les normes et réglementations en matière de qualité prennent de plus en plus d'importance et sont encouragées dans le cadre de l'approbation des thérapeutiques, de la facturation et des incitations financières. Dans ce contexte, ces réglementations mettent l'accent, à des degrés divers, sur des critères de structure, de processus ou de résultats. Au nom de la Société Suisse de Psychiatrie et Psychothérapie de la Personne Âgée (SPPA) nous résumons dans ce document les éléments de qualité et regroupons les exigences qui en découlent en fonction du setting (ambulatoire, intermédiaire, stationnaire) et des critères de qualité structurelle (clé de répartition du personnel, infrastructure). Il existe une vaste matrice d'exigences dont la mise en œuvre requiert des efforts considérables, entre autres en raison de la pénurie de personnel qualifié et des ressources financières limitées des institutions et des cabinets médicaux. Les critères définis dans la matrice d'exigences devraient être développés et ancrés dans une «formation continue en psychiatrie de la personne âgée basée sur les compétences¼.

[Experience-based items of quality in psychiatric treatment: A first multivariate construct]. / Erlebensbezogene Qualitätsmerkmale für die psychiatrische Behandlung: Vorstellung eines vorläufigen multivariaten Konstrukts.

In the context of psychiatric care, user-generated measurement instruments may contribute to quality development and assurance. An explorative construct of experience-related quality components was developed in participative-collaborative cooperation that grasps the users' experiences of psychiatric care. After developing the components using a grounded theory methodology, they were quantified, and their interrelations were investigated using a multidimensional scaling method to explore their internal cohesion. The construct makes it possible to separate structural from interpersonal requirements of the quality components. It further indicated which components are more feasible for the home treatment setting, and which ones for an institutional setting. The components and the construct may be perceived as first steps towards the development of user-generated quality indicators; however, further validation steps are necessary.

[How robust are studies of currently permanently included digital health applications (DiGA)? Methodological quality of studies demonstrating positive health care effects of DiGA]. / Wie belastbar sind Studien der aktuell dauerhaft aufgenommenen digitalen Gesundheitsanwendungen (DiGA)? Methodische Qualität der Studien zum Nachweis positiver Versorgungseffekte von DiGA.

INTRODUCTION: Since September 2020 digital health applications (DiGA) can be prescribed by physicians and psychotherapists and are reimbursed within the German Statutory Health Insurance (SHI) system for the first time worldwide. For full reimbursement, the manufacturers have to provide evidence based on scientific studies that the DiGA can provide 'positive health care effects'. This study aims to analyze and evaluate the methodological quality of efficacy studies of DiGA in the categories 'Nervensystem' and 'Psyche' of the DiGA register that are permanently accepted. METHODS: The methodological quality was assessed using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The risk of bias was assessed for the primary endpoint of each study according to an intention-to-treat analysis. RESULTS: Six DiGA were assessed for their methodological quality. Randomized controlled trials were conducted for all 6 DiGA that showed a high risk of bias, which was, in particular, due to a lack of blinding of the studies. In addition, drop-outs were significantly higher in the intervention group than in the control group in most studies. For most of the DiGA no published study protocol was available in advance so an analysis of a potential selective choice of the evaluation methodology was not possible. DISCUSSION: For reasons of transparency, verifiability, and comprehensibility of the study results, registration in a study registry and, more importantly, the publication of study protocols should be mandatory before the start of the studies. In addition, studies should be blinded by comparing the DiGA with a 'sham application' to reduce the high risk of bias. Differences in the drop-out rates of the investigated studies could indicate a lack of efficacy of the treatment in the intervention group, (technical) problems in the application of the DiGA, or a lack of motivation of the participants. CONCLUSION: The interim results 18 months after the introduction of DiGA in the German SHI system show that the studies on the evidence of the benefits of DiGA have a high potential for bias in certain areas. However, it should be positively emphasized that the manufacturers submitted randomized controlled trials to prove the medical benefit of the DiGAs investigated.

Niveles de calidad de vida en niños, adolescentes y adultos con discapacidad y en su sistema familiar, durante la pandemia por COVID-19 en una muestra latinoaméricana / Nivells de qualitat de vida en nens, adolescents i adults amb discapacitat i en el seu sistema familiar, durant la pandèmia per COVID-19 en una mostra llatinoamericana / Quality of life levels in children, adolescents, and adults with disabilities and their family system during the COVID-19 pandemic in a Latin American sample

Este estudio se propuso describir la calidad de vida de niños y adultos con discapacidad, así como la calidad de vida de su sistema familiar en una muestra de Latinoamérica. Se utilizaron los instrumentos WHOQOL-BREF y PedsQL 4.0. Los resultados mostraron una baja calidad de vida de todos los grupos estudiados, principalmente en la dimensión social para adultos y niños, y en las dimensiones de preocupaciones y actividades diarias para su familia. Esta población parecería verse particularmente afectada durante la pandemia por COVID-19.(AU)

This study aimed to describe the quality of life of children and adults with disabilities, as well as the quality of life of their family system in a Latin American sample. The WHOQOL-BREF and PedsQL 4.0 instruments were used. The results showed low quality of life for all groups studied, mainly in the social dimension for adults and children, and in the dimensions of concerns and daily activities for their families. This population seems to be particularly affected during the COVID-19 pandemic.(AU)

Aquest estudi es va proposar descriure la qualitat de vida de nens i adults amb discapacitat, així com la qualitat de vida del seu sistema familiar a Llatinoamèrica. Es van utilitzar els instruments WHOQOL-BREF i PedsQL 4.0. Els resultats van mostrar una baixa qualitat de vida de tots els grups estudiats, principalment en la dimensió social per a adults i nens, i en les dimensions de preocupacions i activitats diàries per a la família. Aquesta població semblaria veure's particularment afectada durant la pandèmia per COVID-19.(AU)

[Quality Standards in Old Age Psychiatry]. / Qualitätsstandards in der Alterspsychiatrie.

Quality Standards in Old Age Psychiatry Abstract. Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements, matrix must be further developed and anchored in a "competence-based training in old age psychiatry".

[Quality assurance follow-up survey of the ELISA cohort study on the prevalence of COVID-19: The view of study participants - What is well received?] / Nachbefragung zur Qualitätssicherung der ELISA-Kohortenstudie zur COVID-19-Prävalenz: Die Sicht von Studienteilnehmerinnen und Studienteilnehmern ­ Was kommt gut an?

INTRODUCTION: With the outbreak of the Corona pandemic, the LübEcker longitudinal study on infections with SARS-CoV-2 (ELISA study) was conducted in the Lübeck area to provide information on the prevalence, unreported cases and symptoms of COVID-19. The aim of the present study is to evaluate defined structure and process indictors of the study conduct of the ELISA study by subjects. METHODS: After defining and operationalizing participant-oriented quality indicators, 3,710 participants were surveyed online via LimeSurvey. Indicators defined were access to the study, time requirements, reporting of findings, ratings of the study apps used, communication, study center, tolerability of sample collection, and willingness to re-participate. In addition, comments on push and pull factors of study participation could be made. The evaluation was both quantitative and qualitative. RESULTS: 45% of the follow-up respondents (n=1,684) answered the questions on the defined structural and process indicators. In the quantitative part of the survey, tolerability of venous blood sampling was rated as significantly better than that of nasopharyngeal smears. 91% of the follow-up respondents welcomed the offer to view their findings in the personal results portal. Overall, the indicators were mostly rated positively. According to the qualitative data, the study participants found the win-win situation of the test opportunity to contribute to research, the local relevance of the study, the small incentives, and the low-threshold nature of the study registration to be positive aspects of the study. According to the quantitative data, participants suggested improving the usability of the digital applications in terms of more user-friendly identification solutions, reminder functions, announcements of software updates and avoidance of double entries. DISCUSSION: The defined structure and process indicators appear to be suitable for assessing the quality of study implementation from the subjects' point of view and indicate a good quality of study implementation under pandemic conditions. The lowest participation rate (75%) was measured at the fifth test time of strongly declining COVID-19 infections during the summer holidays in Schleswig-Holstein. Obviously, the benefit and meaningfulness of further study participation as well as competing factors were weighted differently by the subjects at this point. The follow-up survey suggests a variety of options for motivating participants to maintain a high level of participation. Possible limitations are that a non-response bias cannot be excluded for the follow-up survey and that no suitable standardised questionnaire was available. CONCLUSION: The present study provides recommendations for the planning of future cohort studies. It makes sense to continuously evaluate the motives for participation or non-participation and to explicitly consider them in the course of the study. Therefore, the definition of general quality indicators for the practical implementation of studies seems desirable. Positive experiences of the participants in connection with study participation are important, such as good time management, short response times, technical support offers and additional services such as a study homepage with frequently asked questions (FAQs), timely individual notifications of results and transparent, generally understandable information about study results during the study. Digital solutions are well received, but can still be improved for specific studies.

[Burnout Symptoms Among Child and Adolescent Psychiatric/Psychotherapy Professionals During the 2020/2021 Winter Lockdown of the Covid-19 Pandemic]. / Burnout-Symptome bei Fachkräften in der Kinder- und Jugendpsychiatrie/Psychotherapie während des Winter-Lockdowns 2020/2021 der COVID-19-Pandemie.

Burnout Symptoms Among Child and Adolescent Psychiatric/Psychotherapy Professionals During the 2020/2021 Winter Lockdown of the Covid-19 Pandemic Abstract. Question: Professionals in clinics and Departments of Child and Adolescent Psychiatry/Psychotherapy are often confronted with stress during their daily work. Such psychological pressure can cause stress symptoms such as burnout. This article examines the consequences of burnout symptoms at the institutional level, such as staff turnover. Method: We examined the connection between burnout symptoms and the institutional consequences of presenteeism, absenteeism, turnover tendency, and reduced quality of job performance during the winter lockdown (2020/2021) of the Covid-19-pandemic at psychiatric hospitals or departments for children and adolescents in Germany using a sample of N = 172 professionals. Results: The results show that signs of burnout symptoms impact the turnover tendency, presenteeism, and job performance of professionals. In addition, evidence emerged that professionals were more stressed during the winter lockdown (2020/2021) of the Covid-19 pandemic, and that this influenced turnover tendency, presenteeism, and absenteeism as well as the quality of job performance. Conclusion: Work-related stress of professionals should be addressed early to protect clinics and departments for child and adolescent psychiatry/psychotherapy from potential consequences, and to ensure care connectivity and quality of care.

[What patients judge as important regarding nursing quality: Content analysis of patients' responses to an open-ended question within an online survey]. / Was Patient_innen an Pflegequalität noch wichtig ist.

What patients judge as important regarding nursing quality: Content analysis of patients' responses to an open-ended question within an online survey Abstract. Introduction: In a cross-sectional study with people insured by a health insurance company the association between the quality of care assessed by patients and nurse staffing in acute care hospitals has been investigated. A systematically developed online questionnaire registered the patients' assessments of nursing care, nursing behavior and nursing outcomes. The questionnaire included an open-ended question that was designed to supplement other important aspects where appropriate. Research question: Which aspects of the experienced care were particularly important for the patients but were -from their point of view- not yet covered by the questionnaire? Can additional indicators of care quality be derived? Method: Online survey following hospital discharge. Content analysis of the free text entries to the open-ended question. Results: A total of 212554 insured people were contacted; 30209 participated in the survey (14,2%) and 12507 (41,4%) of them answered to the open-ended question. A random selection of free text replies (n=2000) was finally coded and analyzed. Altogether, 45,1% of all codes covered the aspects of care quality included in the questionnaire. Of the remaining codes, 35,1% contained statements about non-nursing quality aspects of hospitalization and 19,8% contained statements about working conditions. No additional indicators of quality of care could be identified. Conclusion/Outlook: The statements about the working conditions will be explored in a further analysis. The expectations of patients towards nursing care need to be investigated in future studies.

[GRADE Guidelines: 19. Assessing the certainty of evidence in the importance of outcomes or values and preferences: Risk of bias and indirectness]. / GRADE-Leitlinien: 19. Bewertung der Vertrauenswürdigkeit der Evidenz für die Bedeutung von Endpunkten oder Werten und Präferenzen ­ Risiko für Bias und Indirektheit.

OBJECTIVES: The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group defines patient values and preferences as the relative importance patients place on the main health outcomes. We provide GRADE guidance for assessing the risk of bias and indirectness domains for certainty of evidence about the relative importance of outcomes. STUDY DESIGN AND SETTING: We applied the GRADE domains to rate the certainty of evidence in the importance of outcomes to several systematic reviews, iteratively reviewed draft guidance and consulted GRADE members and other stakeholders for feedback. RESULTS: This is the first of two articles. A body of evidence addressing the importance of outcomes starts at "high certainty"; concerns with risk of bias, indirectness, inconsistency, imprecision, and publication bias lead to downgrading to moderate, low, or very low certainty. We propose the following subdomains of risk of bias: selection of the study population, missing data, the type of measurement instrument, and confounding; we have developed items for each subdomain. The population, intervention, comparison, and outcome elements associated with the evidence determine the degree of indirectness. CONCLUSION: This article provides guidance and examples for rating the risk of bias and indirectness for a body of evidence summarizing the importance of outcomes.

[Patient and public involvement in clinical research: An introduction]. / Aktive Beteiligung von Patient*innen an klinischer Forschung ­ Eine Einführung.

Usually, patients participating in clinical trials have a passive role as test persons. This creates a risk that patients' needs and interests are not reflected in clinical research. The aim of the present paper is to give an introduction to patient involvement in clinical research. It is based on an exploratory literature research and our own experiences with patient involvement. By actively involving patients in the design, conduct and translation of clinical trials, research and healthcare can be better tailored to meet the patients' needs. Patient involvement has the potential to enhance the quality and relevance of research, support patient empowerment and contribute to the democratisation of research processes. There are different methods to involve patients in research, which are often differentiated as consultation, cooperation and user-led research. Methods, time of involvement and persons to be involved should be chosen to fit the aims of the involvement. While cultural, practical and personal barriers could hinder patient involvement, there are several strategies that enable effective involvement: defining the aims of the involvement, clarifying motivation and expectations as well as roles and the form of cooperation, offering training, planning sufficient resources, involving patients from the start and communicating the benefits of involvement.

[Quality indicators for medication reviews in community pharmacies]. / Qualitätsindikatoren zur Bewertung von Medikationsanalysen in öffentlichen Apotheken.

BACKGROUND: Medication reviews conducted in community pharmacies are a measure to reduce drug-related problems and to increase medication safety. Since 2014, a guideline for medication reviews has been available in Germany. However, the sole existence of a guideline does not guarantee a high quality of this novel service. Quality indicators can contribute to ensure appropriate quality standards. So far, no such indicators have been available in Germany. This project therefore aims at developing suitable indicators to assess the quality of medication reviews type 2a in community pharmacies. METHODS: Based on a literature review, potential quality indicators were generated. Using a two-step Delphi method applying the RUMBA criteria, a set of structure, process, and outcome indicators was developed. RESULTS: The literature review identified 23 potential indicators. Nine further indicators derived from the guideline for medication reviews and expert opinion were amended. After discussion in a focus group, the 32 indicators were reduced to a preliminary set of twelve indicators used for the Delphi survey. Following two Delphi rounds, a final indicator set consisting of three structure indicators, one process indicator and two outcome indicators, was generated. DISCUSSION: The set of quality indicators is potentially suitable for measuring the quality of medication reviews in German community pharmacies. In the next step, these indicators need to be evaluated with regard to their validity and applicability in daily routine.