[Staffing situation in home-care services: A qualitative study on current and future challenges]. / Die Personalsituation in der ambulanten Pflege.

Staffing situation in home-care services: A qualitative study on current and future challenges Abstract. Background: There are increasing signs of staff shortages in home-care nursing in Germany. Home care providers have an increasing number of vacancies and the provision of care for people in need of care is a challenge. There are only a few approaches to planning personnel requirements in home care and the existing ones are rather complex. Aim and research question: The objective of this study was to gain insights into how staff deployment and staff planning currently take place in German home care services and to evaluate options for the development of staffing measures in home care. Methods: Qualitative, guideline-based expert interviews (N = 33) were conducted and analyzed. Experts were representatives of home care service providers, advisors of home care service providers and experts in the field of human resources management. Data analysis was performed by using content analysis. Results: From the experts' point of view home care services cannot ensure sufficient provision of home care services as needed by care-recipients due to staff shortages. Staff planning as well as recruitment and retention of staff pose an increasing challenge. Staff planning is mainly determined by contractual requirements and the reimbursement system. It is less determined by individual care-recipients' needs. The company size of home care providers depends on staff recruitment and turnover. Conclusions: The staffing situation will be a remaining challenge in the foreseeable future. It will go along with the task to ensure an adequate home care supply. Approaches that go beyond reimbursement driven personnel planning can contribute valuable hints for the future.

[Exergames to promote physical activity and mobility in inpatient long-term nursing-An overview]. / Exergames zur Förderung der körperlichen Aktivität und Mobilität in der stationären Langzeitpflege ­ Ein Überblick.

Maintaining and promoting mobility is a key objective and central goal of nursing care. Active video games or so-called exergames can also be used for this purpose. In the group of older people some studies showed indications of positive effects with respect to mobility. In this article the focus is on studies that examined the use of exergames for the purpose of maintaining or promoting physical activity and mobility in the setting of long-term inpatient nursing. In summary, a literature search in databases indicated that individual studies on this topic found indications of positive effects: however, the informative value of the results is limited due to their heterogeneity and small samples.

Workforce issues in home- and community-based long-term care in Germany.

The study addresses staffing and workforce issues for home- and community-based long-term care in Germany. It is based on a study aimed at developing staffing recommendations for home-care provider organisations. The study was commissioned within the regulation of the German long-term care act. Following an exploratory literature search on staffing issues in home- and community-based care qualitative interviews with 30 experts in home care were conducted. In addition, time needed for different interventions in homes of people in need of care (n = 129) was measured. Ethical approval for the study was obtained. The literature on the topic is limited. In Germany, no fixed staff-to-client ratio exists, but staffing is determined primarily by reimbursement policies, not by care recipients' needs. The results of the interviews indicated that staffing ratios are not the main concern of home-care providers. Experts stressed that general availability of staff with different qualification levels and the problems of existing regulation on services and their reimbursement are of higher concern. The measurement of time needed for selected interventions reveals the huge heterogeneity of home-care service delivery and the difficulty of using a task-based approach to determine staffing levels. Overall, the study shows that currently demand for home-care exceeds supply. Staff shortage puts a risk to home care in Germany. Existing approaches of reimbursement-driven determination of staffing levels have not been sufficient. A new balance between staffing, needs and reimbursement policies needs to be developed.

Different pattern of stool and plasma gastrointestinal damage biomarkers during primary and chronic HIV infection.

INTRODUCTION: Primary HIV infection (PHI) is the initial phase after HIV acquisition characterized by high viral replication, massive inflammatory response and irreversible immune-damage, particularly at the gastrointestinal level. In this study we aimed to characterize the dynamics of gastrointestinal damage biomarkers during the different phases of HIV infection and assess their association with HIV-disease markers and their accuracy to differentiate PHI from chronic HIV infection (CHI). METHODS: PHI-individuals (n = 57) were identified as HIV-seronegative/HIV-RNA positive and were followed up for one year at the Manhiça District Hospital in Mozambique. Ten plasma and 12 stool biomarkers were quantified by Luminex or ELISA and levels were compared to CHI-naive (n = 26), CHI on antiretroviral-treatment (ART; n = 30) and HIV-uninfected individuals (n = 58). Regression models adjusted by time point were used to estimate the association of the biomarkers with HIV-disease markers. Receiver operating curves were compared for the best accuracy to distinguish PHI from CHI. RESULTS: Soluble (s)CD14 was significantly associated with the CD4/CD8 ratio (P < 0.05) and viremia levels (P < 0.0001) during PHI. Plasma zonulin and stool lactoferrin were significantly higher in PHI as compared to CHI-individuals (P < 0.05). Plasma zonulin demonstrated the best accuracy to identify PHI among HIV-infected individuals (AUC = 0.85 [95% CI 0.75-0.94]). Using a cutoff value of plasma zonulin ≥ 8.75 ng/mL the model identified PHI with 87.7% sensitivity (95% CI 76.3-94.9) and 69.2% specificity (95% CI 48.2-85.7). An adjusted multivariate model including age, plasma zonulin and sCD14 further increased the classification performance (AUC = 0.92 [95% CI 0.86-0.99]). CONCLUSIONS: While the stool biomarkers did not provide any predictive ability to distinguish PHI from CHI-individuals, plasma sCD14 and zonulin were significantly associated with HIV-disease markers and PHI identification, respectively. These inflammatory biomarkers may be useful to monitor changes in gastrointestinal integrity during HIV infection.