[Low-threshold consulting services for dementia : Quality criteria from a provider's point of view]. / Niedrigschwellige Beratungsangebote bei Demenz : Qualitätskriterien aus Sicht der Leistungserbringer.

BACKGROUND: Low-threshold consulting services are becoming increasingly more important as an addition to outpatient and inpatient services. OBJECTIVE: What quality criteria do providers of low-threshold consulting services for family caregivers of people with dementia have? MATERIAL AND METHODS: Telephone interviews with 36 providers of family counseling, support groups, care course. Qualitative content analysis according to Mayring complemented by a literature search. RESULTS: The quality criteria of the providers are based on frequent, ongoing, daily life-oriented, family-oriented, relief-providing, professional, and cross-linked services. CONCLUSION: Increased cooperation and coordination of all involved stakeholders is necessary to improve the knowledge and utilization of the services and the qualitative orientation.

["As Good as it Gets at Home" - Reasons for Institutionalisation in Dementia]. / "Zuhause geht es nicht mehr" - Gründe für den Wechsel ins Pflegeheim bei Demenz.

AIM: What are the reasons for institutionalising community-dwelling persons with dementia? METHOD: A written survey of family caregivers and general practitioners was undertaken. RESULTS: Within 2 years 47 of 351 people with dementia (13%) were institutionalised. The person with dementia was involved in the decision in only 1/3 of the cases. The 3 most common reasons were: ensuring the best possible care, high expenditure of care-giving time at home, deterioration of the health of the care-receiver. CONCLUSIONS: From the ethical point of view the exclusion of the persons with dementia from the decision-making with regard to institutionalisation has to be examined critically. The often given reason of ensuring the best possible care through institutionalisation could be counteracted by the improvement of community-based care.

[Evidence-based health services research--a short review and implications]. / Versorgungsforschung--evidenzbasiert Ein Kurzüberblick und Implikationen.

BACKGROUND: Health services research aims to generate knowledge about care processes of people with illnesses who access health-care services. In addition, the consequences of those processes in the care routine concerning the involved persons and the health system are analyzed. CONCEPT OF THE THEORETICAL WORK: In the first part of the manuscript, an overview concerning the current definitions and subsumptions of the concept of health services research is given. The second part of the manuscript focuses on demonstrating how evidence-based health services research can be used to enable optimization of the care system. The concept is called the "circle of care optimization". In the first step the current care situation concerning its deficits and their reasons is analyzed. In the second step a relevant care goal is defined. In the third step an improvement of an existing care process is developed to achieve the defined care goal. In the fourth step, a comparative empirical study with a high-quality study design is carried out, to assess whether the improved care process is superior to the current care as usual. A health economic evaluation will be performed if applicable. If the results show no or only small advantages, the "circle" starts again with step 3. However, if the results show a significant effect in favour of the new care process and are relevant for the delivery of care and efficient in the context of health economics, a fifth step will be performed which involves developing and testing strategies for implementation. Where relevant, the consequences of implementation are investigated in a sixth step. A "best-practice" practical example is demonstrated to illustrate the "circle of care optimization". CONCLUSIONS: conclusions are derived by illustrating future challenges for health services research.

[Memorandum 'Development of health services research in Bavaria from the perspective of the Bavarian State Working Group 'Health Services Research (LAGeV)': status quo - potential - strategies']. / Memorandum "Weiterentwicklung der Gesundheitsversorgungsforschung in Bayern aus Sicht der Landesarbeitsgemeinschaft Gesundheitsversorgungsforschung: Status quo - Entwicklungspotenziale - Strategien".

The aim of the memorandum on the development of health services research (HSR) in Bavaria is to operationalise the global objectives of the State Working Group "Health Services Research" (LAGeV) and to collectively define future topics, specific implementation steps, methods as well as ways of working for the future course of the LAGeV. The LAGeV is an expert committee that integrates and links the competencies of different actors from science, politics and health care regarding HSR and facilitates their cooperation. The memorandum is based on an explorative survey among the LAGeV members, which identified the status quo of health services research in Bavaria, potential for development, important constraints, promoting factors, specific recommendations as well as future topics for the further development of HSR in Bavaria. From the perspective of the LAGeV members, the 12 most important future topics are: 1) Interface and networking research, 2) Innovative health care concepts, 3) Health care for multimorbid patients, 4)Health care for chronically ill patients, 5) Evaluation of innovations, processes and technologies, 6) Patient orientation and user focus, 7) Social and regional inequalities in health care, 8) Health care for mentally ill patients, 9) Indicators of health care quality, 10) Regional needs planning, 11) Practical effectiveness of HSR and 12) Scientific use of routine data. Potential for development of HSR in Bavaria lies a) in the promotion of networking and sustainable structures, b) the establishment of an HSR information platform that bundles information and results in regard to current topics and aims to facilitate cooperation as well as c) in the initiation of measures and projects. The latter ought to pinpoint health care challenges and make recommendations regarding the improvement of health care and its quality. The cooperation and networking structures that were established with the LAGeV should be continuously expanded and be used to work on priority topics in order to achieve the global objectives of the LAGeV.

Correlation between coping strategies and subjective assessment of the voice-related quality of life of patients after resection of T1 and T2 laryngeal tumours.

When coming to terms with a diagnosis of laryngeal cancer, patients find different ways of coping with their illness. These may or may not be related to communication. Vocal aspects of quality of life are particularly important with cancer of the larynx. The correlation between coping and subjective assessment of the voice-related quality of life was assessed in a cross-sectional study of patients after resection of T1 and T2 laryngeal tumours. As part of follow-up care, 55 male cancer patients with partial laryngectomy were asked about their voice-related quality of life and their coping strategies. The Voice-Related Quality of Life Questionnaire (V-RQOL) and the Trier Coping Scales (TCS) were used as survey instruments. The voice-related quality of life of the patients was assessed on average as medium to good. The coping strategy most frequently chosen by patients was 'threat prevention', followed by 'search for social integration', 'rumination', 'search for information and experience exchange' and 'search for support in religion'. Correlations between coping strategy and the voice-related quality of life were weak to moderate and somewhat inconsistent in this patient population. There was no consistent or strong correlation between voice-related quality of life and coping strategies in male patients with partial laryngectomy, so that individual differences appeared to be more important in coping with illness than primarily voice-related factors such as the voice-related quality of life.

[Voice-related quality of life vs. health-related quality of life after partial laryngectomy]. / Stimmbezogene und allgemeine gesundheitsbezogene Lebensqualität kehlkopfteilresezierter Patienten.

BACKGROUND: The assessment of the treatment results of laryngeal cancer includes subjective aspects. Two tools for assessment of the quality of life of patients after treatment of small laryngeal carcinoma were compared: The disease-unspecific short-form-36 health-survey (SF-36) and the specific voice-related-quality-of-life-questionnaire (V-RQOL). MATERIAL AND METHODS: Data of 65 patients after partial laryngeal resection was evaluated during regular out clinic examinations. RESULTS: The average V-RQOL total score was 70,0 ± 24,3. Similar results were achieved for the physically (68,2 ± 24,3) and for the emotional (72,5 ± 27,6) subscores of the V-RQOL-survey being lower than the cut-off for healthy voices, which is at 80 points. The SF-36-health survey score was 43,0 ± 10,7 for the physically subscore and 50,2 ± 9,1 for the emotional subscore. Both subscores were rated worse than the age-adjusted standard value for the SF-36. There is a moderate correlation between both questionnaires, which does not depend from the size of the laryngeal carcinoma (T1 or T2). CONCLUSION: The voice-related quality of life is part of the health-related quality of life next to other factors. An amelioration of voice-related quality of life thus should lead to better general, health-related quality of life.

Voice handicap index and voice-related quality of life in small laryngeal carcinoma.

Laryngeal cancer can affect the patients' voice. For assessment of the patients' self-perception of their voice, several tools were introduced into clinical routine. The voice handicap index questionnaire (VHI) is regarded as the "gold standard". However, in benign laryngeal pathologies and in functional dysphonia, the shorter voice-related quality of life questionnaire (V-RQOL) proved to be equivalent. This study examines the correlation of both questionnaires in patients who had been treated for small (T1 and T2) laryngeal cancer. It was performed during regular outclinic examinations. In total, 65 patients aged 62.1 ± 10.0 years completed the German versions of the VHI and V-RQOL. Their average VHI total score was 38.9 ± 26.0 points and the average V-RQOL score was 70.1 ± 24.4%. The total scores correlated with |ρ| = 0.92 and p < 0.01. Both questionnaires give quasi identical results, the shorter V-RQOL may be favoured for clinical application.

[Swallowing-related quality of life in oral cavity cancer. The German version of the Anderson Dysphagia Inventory]. / Schluckbezogene Lebensqualität bei Mundhöhlenkarzinomen. Anderson-Dysphagia-Inventory, deutsche Version.

BACKGROUND: The objective of this study was to validate the German version of the Anderson Dysphagia Inventory (ADI), as well as to grade it by using health-related quality of life as an external criterion. PATIENTS AND METHODS: A total of 102 patients (26 women, 76 men) aged 34-90 years (61.1+/-10.8) with a treated squamous cell carcinoma of the oral cavity participated in the study. All study participants independently completed the German version of the ADI and the SF-36 questionnaire on health-related quality of life. The German ADI was tested for its validity and reliability, and subjected to a factor analysis. RESULTS: The internal consistency reliability of the ADI was calculated using Cronbach's alpha coefficient and was equal to 0.942. In the split-half reliability the Spearman-Brown coefficient scored 0.916. Factor analysis showed a one-factor result. The correlation coefficients between the point scores of the German ADI and the following clinical parameters demonstrated construct validity: radiation (p<0.001), T-classification (p=0.002), surgical method (p=0.018), not, however, tumor site (p=0.115). The grading system was as follows: scores <55 are regarded as "definitely noticeable"; scores 55-70 are considered as "more noticeable than not"; while scores >70 are classified as " more unnoticeable than not". CONCLUSION: The German translation of the ADI is a validated and reliable method to assess swallowing-related quality of life.

[Turkish emigrants in Germany. Deficits in home care knowledge and health services - a review]. / Türkische Migranten in Deutschland. Wissens- und Versorgungsdefizite im Bereich häuslicher Pflege - ein Überblick.

Family members caring for relatives at home are often under great stress. Numerous studies have shown that taking care of a chronically ill family member may have negative effects on physical and emotional health. Frequent symptoms observed in family caregivers are insomnia, joint pain, physical exhaustion, and depression. There are, as yet, no definitive empirical studies in Germany on the subjective burden of family caregivers in Turkish families and on their specific needs for help, although their numbers are increasing exponentially. The statement based on the low rate of use of professional care by Turkish families in Germany that there is great willingness among Turkish families to take care of family members at home - a self-evident part of the concept of family - should not lead to the assumption that care causes less stress in this population. There is a great need for research into the way in which the care situation and the changes attendant thereon are experienced by Turkish family caregivers. Recording of subjective burden and individual needs is important to develop accepted strategies to relief Turkish family caregivers.

[Voluntary help in dementia - predictors for utilisation and expected quality from a family caregiver's point of view]. / Ehrenamtlicher Betreuungsdienst bei Demenz - Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger.

Although support services are considered cost-effective in the relief of care-giving family members of dementia patients, there has been little research to date on the predictors of use and quality expectations. These two questions are examined for the first time based on cross-sectional data of 404 care-giving family members, users and non-users of voluntary help services. Quantitative data are evaluated using binary logistical regression analysis, qualitative data using content analysis. The rating of how helpful the use of a voluntary help service is in the personal situation was found to be the only significant predictor of use. With respect to quality, it is most important that the persons giving support be punctual and well-trained. To increase the rate of use, care-giving family members must be convinced of the relevant benefits of using a voluntary help service. In addition, attention must be paid to the professional organization and training of voluntary helpers.

[Binge drinking in adolescents and young adults]. / Rauschtrinken bei Jugendlichen und jungen Erwachsenen.

Various studies in industrialised European and non-European countries have expressed concern about the link between alcoholic drinks (e. g. alcoholic sodas, so called "alcopops") and binge drinking in adolescents and young adults. Binge drinking has been shown to be associated with considerable social harm and disease burden. Adolescent alcohol abuse including binge drinking is common, but the extent of the problem and the specific risk factors leading to binge drinking behaviour remains unclear. Although the long-term health of adolescent binge drinking has not been studied in detail, first studies report an elevated risk for physical injury, aggression, violent or driving offences while intoxicated and high-risk sexual behaviour. To date, a variety of socio-demographical characteristics associated with binge drinking have been studied. However, knowledge in this area is limited, as most research has been conducted among specific groups (i. e. North American college students, adolescents in Australia etc.). More and intensive research in Germany and other European countries is urgently needed, as results from other cultural backgrounds are not necessarily transferable.

[Cost-effectiveness model of a community-based service for dementia caregivers]. / Kosteneffektivitätsmodell eines ambulanten Hilfeangebotes für pflegende Angehörige von Demenzkranken.

OBJECTIVE: The objective of this study was to compare the cost-effectiveness of a psychoeducational concept for dementia caregivers with standard care. METHODS: A literature search determined the data for the cost-effectiveness model concerning the quality-adjusted life years (QALYs) and costs. The parameters were evaluated using a decision tree. The evaluation of the base case analysis concerning stability was carried out using sensitivity analysis and a Monte Carlo simulation (MCS). RESULTS: After the implementation of the psychoeducational concept for caregivers a saving of 750 euro was made and a 0.07 QALY was gained over a one-year time horizon. The results of the sensitivity analysis proved to be stable. CONCLUSIONS: By using the community-based service, costs can be saved and QALYs of the caregivers can be gained. This results in a decrease of depressive symptoms among caregivers and in a delay of institutionalisation of the dementia patient.

[Stroke etiology and long-term need of care in ischemic stroke patients]. / Schlaganfallursache und Pflegebedürftigkeit im Langzeitverlauf.

About 80 % of all strokes are of ischemic origin. Among these the Trial of ORG 10 172 in Acute Stroke Treatment (TOAST) classification denotes five the etiological categories: large-artery atherosclerosis, cardioembolism, small-artery occlusion, strokes of undetermined etiology and strokes of other determined etiology, which are based on imaging and diagnostic findings. The object of research is the distribution of these TOAST categories in a demographically defined population and their impact on the need of care. The present study involves patients recruited within the population-based Erlangen Stroke Project (ESPro). The patients were analysed at time points after admission as well as 3 and 12 month after the event. results were presented as adjusted Odds Ratios (aOR). 1355 patients with a first-ever-in-a-lifetime ischemic stroke were registered in the Community of Erlangen. TOAST classification could be performed in 89 % (1206) of ischemic strokes. The etiological classification of brain infarctions resulted in 12 % large-artery atherosclerosis, 26 % cardioembolism, 24 % small-artery occlusion, 37 % strokes of undetermined etiology and 2 % strokes of other determined etiology. While 20 % of the patients were independent functionally at the Barthel index at admission, the number was 39 % after 12 month. The category large-artery atherosclerosis showed the strongest relationship with the occurring need of care. The aOR with very strong care needs 12.79 (95 % CI 3.71 -44.07) lay particularly high in comparison with an aOR of 6.95 (95 % CI 2.16 - 22.33) in the category cardioembolism. The TOAST classification provides an appropriate tool for estimating the need of care. In particular the patients in the TOAST category large-artery atherosclerosis showed a high level of a need of care at the long-term follow-up.

[Quality of life in dysphonia]. / Lebensqualität bei Dysphonien.

Quality of life is multidimensional and comprises physical, emotional, and social aspects. It has always been the implicit focus of medical work. However, since the 1980s it has been possible to measure it explicitly. Quality of life is impaired in dysphonic patients; this finding is supported by specific studies on self-reported physical, emotional, and social well-being. For practical application of these data, it is recommended to measure all three domains. From a therapeutic point of view, verbal intervention following the PLISSIT model (permission, limited information, special suggestions, intensive therapy) has been proven to enhance patient satisfaction. Therefore, this clinical procedure is recommended for routine application in dysphonic patients.

[Grading of the voice-related quality of life index]. / Graduierung des Voice-Related-Quality-of-Life-Index.

BACKGROUND: Although the voice-related quality of life (VRQOL) questionnaire has proved to be an appropriate diagnostic tool, there are no recommendations on how to grade the score. In this study the VRQOL was graded against the background of health-related quality of life. PATIENTS AND METHODS: A total of 105 patients (56 women and 49 men) aged 49.4+/-16.1 years who presented with dysphonia of benign origin completed a German version of the VRQOL and the SF-36 health survey after giving informed consent. There was an organic disorder in 50%, in 37% a functional disorder and 13% had no disorder. RESULTS: The only difference between the results of the VRQOL and the SF-36 was in the subscale on social functioning which showed a moderately strong (r(S)=0.40) and highly significant reduction in dysphonic patients (p<0.001). These results were therefore used as an external criterion for the graduation of the VRQOL results. The data suggest that VRQOL values of 0-40 can be classified as "clinically relevant deterioration", values of 41-80 as "no clinically relevant deterioration" and values over 80 as "normal" voice-related quality of life". CONCLUSIONS: The suggested grading system simplifies the assessment of individual VRQOL values. Now their clinical relevance as indication and end-point parameters must be investigated.

[Satisfaction of dysphonic patients with psychosomatic assessment and intervention]. / Zufriedenheit dysphoner Patienten mit einer psychosomatischen Diagnostik und Intervention.

BACKGROUND: Comorbid physical and psychological complaints are more common in patients with dysphonia than in the general population. In a prospective randomized study the effects of structured psychosomatic diagnostics and verbal intervention on the satisfaction of patients with dysphonia were investigated. MATERIALS AND METHODS: A total of 54 dysphonic patients (33 women, 21 men, age 51.1+/-16.4 years) with dysphonia (organic n=36, functional n=18) were examined and their subjective experiences were collected by the following psychometric questionnaires: voice-related quality of life (VRQOL), hospital anxiety and depression scale (HADS-D) and the "Giessener Beschwerdebogen" (Giessen questionnaire on physical complaints GBB). Patients were randomized into 2 groups: group 1 (n=27) filled in the questionnaires and the answers were reviewed within the medical consultation. This was followed by an interview on patient satisfaction. In the control group 2 (n=27) a medical examination and consultation were carried out and then questioned on patient satisfaction. The psychometric questionnaires were completed by the patients shortly before leaving the department. RESULTS: The study group 1 was significantly more satisfied than group 2 on different statistic levels according to the items compared. CONCLUSIONS: Patients suffering from dysphonia are positively influenced with respect to patient satisfaction by a structured psychosomatic diagnostic and intervention.

[Care groups. Predictors for utilisation and expected quality from the dementia caregiver's point of view]. / Betreuungsgruppen. Prädiktoren der Inanspruchnahme und Qualitätserwartungen aus Sicht pflegender Angehöriger eines Demenzkranken.

BACKGROUND: To relieve family caregivers of dementia patients the utilisation of care groups should be fostered. In order to do this the influencing factors must be investigated. INVESTIGATION: Which variables of the care situation, the family caregivers and their attitudes act as predictors for the utilisation of care groups? What are the views of family caregivers about the quality of care groups? METHOD: A cross-sectional study was carried out as an anonymous, written survey of family caregivers of dementia patients in four regions of Germany. There was a 20 % response rate and the quantitative and qualitative data from 404 family caregivers were analysed. Predictors for utilisation were evaluated using binary logistic regression analysis. The answers about quality were evaluated using qualitative content analysis. Additionally ten telephone interviews with people from managerial positions in care groups, regarding their concept of quality, were carried out. RESULTS: Besides estimating how helpful the support of a care group is for their own care situation, only the level of education of the caregiver is a significant predictor for utilisation--lower education level, higher utilisation. Family caregivers, who had already had experience with a care group, expressed a wish for an adequate form of occupation for the dementia patient such as physical exercise or play followed by "well-trained" staff and a loving atmosphere in the care group. CONCLUSIONS: In order to increase the rate of utilisation, family caregivers must be convinced of the relevant advantages of using care groups.

[Dementia caregiver skill training--predictors for utilisation and expected quality from the family caregiver's point of view]. / 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.

[Comparison of patient therapy adherence of two structural different memory clinics]. / Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur.

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.