Accuracy of prenatal detection of facial clefts and relation between facial clefts, additional malformations and chromosomal abnormalities: a large referral-center cohort.

PURPOSE: Facial clefts belong to the most common congenital malformations and their prenatal diagnosis is a constant challenge. The aim of this study was to determine the accuracy of prenatal ultrasound in correctly classifying facial clefts. Furthermore, we aimed to specify the distribution of the type of clefts and underlying genetic conditions. METHODS: All fetuses seen with suspected facial cleft in the Department of Obstetrics, Charité - Universitätsmedizin Berlin during a period of 23 years (1999-2022) were included in this retrospective study. Clefts were classified according to the classification of Nyberg. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. RESULTS: 292 patients were included in the study. The most common type of clefts were unilateral cleft lip and palate (CL-P) (53.6%) and bilateral CL-P (30.6%), followed by CL (8.1%), CP (5.1%) and median CL-P (2.6%). The overall pre- and postnatal concordance rate corresponding to a correct prenatal diagnosis was high, 88.9%, ranging from 73.7% (CL) to 93.7% (unilateral CL-P). Most of the median clefts (95.2%) and CP (93.3%) were associated with other sonographic abnormalities, as well as 52.2% of bilateral CL-P. Chromosomal abnormalities, mostly trisomy 13 and trisomy 18, were observed in in the median CL-P (47.6%), bilateral CL-P (31.1%) and CP (26.7%) groups, in contrast to the CL (9.1%) and unilateral CL-P (12.9%) groups. It was exceptional to have a chromosomal abnormality without additional malformations (4.8%). The mortality rate including one late miscarriage, 5 IUFD's, 74 TOPs and 6 palliative cares at birth was 29.8%, particularly high for median clefts (90.5%). CONCLUSION: Prenatal ultrasound exhibited a high accuracy to assess the type of facial clefts with an average rate of 88.9% (73.7%-93.7%) and a concordance rate of up to 93.7%, depending on the type of cleft. The search for additional malformations as well as clarifying underlying genetic conditions is essential. This allows for a targeted counseling of the parents and to best prepare for postnatal care, including surgery by the maxillofacial team.

[Learning care from professionals : Evaluation of an educational program for caregiving relatives]. / Pflege von Profis lernen : Evaluierung eines Edukationsprogrammes für pflegende Angehörige.

BACKGROUND: Caring for relatives is often associated with psychological and physical stress. Caregiving relatives usually slip into the role unprepared and they lack both the knowledge and skills to fulfil the associated tasks. OBJECTIVE: This study tried to measure whether participation in a special educational program affects the trust in one's own ability to care, the quality of life and the stress perception of caring relatives. MATERIAL AND METHODS: A total of 58 caring relatives were recruited to participate in the interventional study with a pre-post design. The intervention involves an 8­month educational program, which was especially developed. The group was asked to answer validated questionnaires (ASKU, EQ-5D and HPS) at three time points (T1, T2, T3). RESULTS: The results showed a significant influence of the educational program on self-efficacy (p = 0.0012) of the participants between T1 and T3. With respect to the subjective quality of life and the perception of stress no significant effects were shown. CONCLUSION: The results showed that the participation of family carers in the educational program has a different influence on the defined parameters. Not only the stable quality of life but also the short-term significant reduction in subjective stress perception directly after the training (T2) can be emphasized as positive indicators for the program.

Digitale Pflegeanwendungen im Pflegealltag: Zwischen Lösung und neuer Herausforderung.

Digital care applications are digital solutions that should improve or stabilise the health of people in need of care and thus maintain their independence. In the future, they are supposed to be increasingly used to cope with the major challenges in geriatric care, especially the shortage of caregivers. Germany has already created the legal framework for embedding digital care applications in standard care. With the help of DiPA, impairments of independence or abilities of the person in need of care are to be reduced and an aggrevation of the need for care is to be counteracted. In order to successfully adopt these applications, health professionals need to be educated about digital solutions in order to reduce their skepticism and promote trust in these solutions.

"Wenn ich groß bin, geh' ich in die Pflege".

The shortage of nursing staff has become even more noticeable and visible since the COVID 19 pandemic, and the experts know that urgent action is needed. An expert from the field of work/organizational psychology describes the reasons why people decide to work in nursing and then stay in their job or turn their backs on it. These range from salary and working conditions to career opportunities. This is also reflected in the descriptions of health and nursing staff about their experiences, wishes and needs.

Quantification of the Link between Timed Up-and-Go Test Subtasks and Contractile Muscle Properties.

Frailty and falls are a major public health problem in older adults. Muscle weakness of the lower and upper extremities are risk factors for any, as well as recurrent falls including injuries and fractures. While the Timed Up-and-Go (TUG) test is often used to identify frail members and fallers, tensiomyography (TMG) can be used as a non-invasive tool to assess the function of skeletal muscles. In a clinical study, we evaluated the correlation between the TMG parameters of the skeletal muscle contraction of 23 elderly participants (22 f, age 86.74 ± 7.88) and distance-based TUG test subtask times. TUG tests were recorded with an ultrasonic-based device. The sit-up and walking phases were significantly correlated to the contraction and delay time of the muscle vastus medialis (ρ = 0.55-0.80, p < 0.01). In addition, the delay time of the muscles vastus medialis (ρ = 0.45, p = 0.03) and gastrocnemius medialis (ρ = -0.44, p = 0.04) correlated to the sit-down phase. The maximal radial displacements of the biceps femoris showed significant correlations with the walk-forward times (ρ = -0.47, p = 0.021) and back (ρ = -0.43, p = 0.04). The association of TUG subtasks to muscle contractile parameters, therefore, could be utilized as a measure to improve the monitoring of elderly people's physical ability in general and during rehabilitation after a fall in particular. TUG test subtask measurements may be used as a proxy to monitor muscle properties in rehabilitation after long hospital stays and injuries or for fall prevention.

Correlation between timed up and go test and skeletal muscle tensiomyography in female nursing home residents.

OBJECTIVES: Tensiomyography (TMG) derived contraction time (Tc) and amplitude (Dm) are related to muscle fibre composition and to muscle atrophy/tone, respectively. However, the link between mobility and TMG-derived skeletal muscle contractile properties in older persons is unknown. The aim of the study was to correlate lower limb skeletal muscle contractile properties with balance and mobility measures in senior female residents of retirement homes in Austria. METHODS: Twenty-eight female participants (aged from 67-99 years) were included in measurements of contractile properties (TMG) of four skeletal muscles: vastus lateralis, vastus medialis, biceps femoris and gastrocnemius medialis. Their balance and mobility performance was measured using a timed up and go test (TUG). RESULTS: Time needed to complete TUG is negatively correlated to biceps femoris (r= -0.490; p= 0.008), vastus lateralis (r= -0.414; p=0.028) and vastus medialis (r= -0.353; p=0.066) Dm and positively correlated to vastus lateralis Tc (r=0.456; p=0.015). Overall, vastus lateralis Tc and vastus medialis Dm explained 37% of TUG time variance. CONCLUSIONS: Our study demonstrates that TMG-derived quadriceps muscle contractile parameters are correlated with the balance and mobility function in female nursing home residents.

Teletherapie ­ eine innovative Therapiemöglichkeit (auch) für ältere Menschen.

Teletherapy enables the provision of therapy services at a distance, supported by the use of information and communication technologies (ICT), for example by means of videoconferencing. This sub-discipline of telemedicine allows, to respond and adapt to global challenges and changing health needs of the population. The Albert Schweitzer Clinic of the Geriatric Health Centers has been using teletherapeutic after-care since the outbreak of the COVID-19 pandemic. The goal is to support patients (Ø 80 years) in carrying out their therapy plan at home after their stay in a geriatric day clinic by using digital media and mobile devices. In this article, we report on their impressions and, together with an expert, explore the question of how teletherapy is being used in Austria.

Pflege & Wissenschaft.

Nursing courses for family caregivers are a public health-relevant offer. Simulation training is an innovative way of building up practical skills for various care situations at home. Simulation training is a learning method that replicates real-life situations to improve the safety, effectiveness and efficiency of healthcare services. Essentially, simulation training provides learners with a controlled and safe learning environment without exposing patients to risk. Simulation training for family caregivers is new. The Albert Schweitzer Training Center at Geriatric Health Centers began offering this hands-on learning method in its family caregiver courses in 2018. In addition to an extensive literature review on this topic, a training participant and a simulation expert report about their experiences with this teaching and learning method.

Machine Learning Based Walking Aid Detection in Timed Up-and-Go Test Recordings of Elderly Patients.

Frailty and falls are the main causes of morbidity and disability in elderly people. The Timed Up-and-Go (TUG) test has been proposed as an appropriate method for evaluating elderly individuals' risk of falling. To analyze the TUG's potential for falls prediction, we conducted a clinical study with participants aged ≥ 65 years, living in nursing homes. We harvested 138 TUG recordings with the information, if patients used a walking aid or not and developed a method to predict the use of walking aids using a Random Forest Classifier for ultrasonic based TUG test recordings. We achieved a high accuracy with an Area Under the Curve (AUC) of 96,9% using a 20% leave out evaluation strategy. Automated collection of structured data from TUG recordings - like the use of a walking aid - may help to improve fall risk tools in future.

Quantitative falls risk assessment in elderly people: results from a clinical study with distance based timed up-and-go test recordings.

OBJECTIVE: A third of people over 65 years experiences at least one fall a year. The Timed Up-and-Go (TUG) test is commonly used to assess gait and balance and to evaluate an individual's risk of falling. APPROACH: We conducted a clinical study with 46 older participants for evaluating the fall risk assessment capabilities of an ultra-sound based TUG test device. The fall protocols over a period of one year were used to classify participants as fallers and non-fallers. For frailty evaluation, state-of-the-art questionnaires were used. Fall recordings were compared to six TUG test measurements that were recorded in fallers and non-fallers. MAIN RESULTS: TUG test data were available for 39 participants (36 f, age 84.2 ± 8.2, BMI 26.0 ± 5.1). Twenty-three participants did fall at least once within the fall screening period. We fitted two different regression and probability models into a region of interest of the distance over time curve as derived from the TUG device. We found that the coefficient of determination for Gaussian bell-shaped curves (p < 0.05, AUC = 0.71) and linear regression lines (p < 0.02, AUC = 0.74) significantly separated fallers from non-fallers. Subtasks of the TUG test like the sit-up time showed near significance (p < 0.07, AUC = 0.67). SIGNIFICANCE: We found that specific features calculated from the TUG distance over time curve were significantly different between fallers and non-fallers in our study population. Automatic recording and analysis of TUG measurements could, therefore, reduce time of measurements and improve precision as compared to other methods currently being used in the assessments of fall risk.

Moving towards a competence centre for geriatric medicine and care: Quality management and human resource management as major support factors.

Changed employment models, an ageing workforce and demands of new generations are challenging healthcare facilities to go down new paths. Never before have well-qualified staff been as highly sought after within the medical and nursing care sector as they are today. For many years, the Geriatric Health Care Centres of the city of Graz (GGZ)-a large regional health care provider with more than 650 staff across five locations-has focused a lot on the topic of competence management, facilitation of specialist and management careers in nursing and medicine as well as the optimal mix of skills and grades in staffing. In addition to competence management, quality management is another prerequisite for systematic staff development. The consistent path of quality management at GGZ has demonstrated for more than 15 years that the regular consideration of quality management systems supports the constant development of human resource management; additionally, it has also demonstrated that it leads to important certifications and prestigious prices: these include the KTQ award for Cooperation for Transparency and Quality in Health Care (Kooperation für Transparenz und Qualität im Gesundheitswesen) in 2010 and 2013, the Austrian Quality Award (Staatspreis Unternehmensqualität) in 2014, the European Quality Award from EFQM (European Foundation for Quality Management) in 2015 and runner-up for the Austrian award for the most family-friendly company (Staatspreis Familienfreundlichster Betrieb Österreichs) in 2014. Furthermore, the competitive edge is sustainably ensured. However, to remain competitive in the labour market and to satisfy the aforementioned requirements, skill-based teamwork and consideration of life-phase-orientation are keys to increase the job and life satisfaction of staff, especially for the mentally and physically draining work with elderly, chronically ill and dying patients. The facilitation of specialist and management careers and age-appropriate workplaces are in turn part of workplace health management of the company. Incorporating workplace health management into the corporate strategy allows health-related management decisions to be made. The integration of health-relevant agendas as strategic management instruments (e.g. the so-called balanced scorecard) is supported by the processes of quality management systems (e.g. EFQM). The strategic corporate objective of GGZ is to increase the health literacy of the population-and by doing so, also increases the health literacy of patients and residents. This kind of patient empowerment can be substantially supported by specially qualified, empathic staff with good social skills and a genuine interest in the elderly; this reinforces the high significance of professional human resource management.