Device-Aided Therapies in Parkinson's Disease-Results from the German Care4PD Study.

Data on the use of device-aided therapies (DATs) in people with Parkinson's disease (PwP) are scarce. Analyzing data from the Care4PD patient survey, we (1) evaluated application frequency and type of DAT in a larger, nationwide, cross-sectoral PwP sample in Germany; (2) analyzed the frequency of symptoms indicative for advanced PD (aPD) and need for DAT amongst the remaining patients and (3) compared the most bothersome symptoms and need for professional long-term care (LTC) of patients with and without suspected aPD. Data from 1269 PwP were analyzed. In total, 153 PwP (12%) received DAT, mainly deep brain stimulation (DBS). Of the remaining 1116 PwP without DAT, >50% fulfilled at least one aPD criterion. Akinesia/rigidity and autonomic problems were most bothersome for PwP with and without suspected aPD, with more tremor in the non-aPD and more motor fluctuations and falls in the aPD group. To recapitulate, the German DAT application rate is rather low, although a large proportion of PwP fulfills aPD criteria indicating a need for intensified treatment strategies. Many reported bothersome symptoms could be overcome with DAT with benefits even for LTC patients. Thus, precise and early identification of aPD symptoms (and therapy-resistant tremor) should be implemented in future DAT preselection tools and educational trainings.

[The situation of physicians in acute hospitals during the second wave of the SARS-CoV-2 pandemic: An online survey]. / Die Situation der Ärztinnen und Ärzte in Akutkrankenhäusern während der zweiten Welle der SARS-CoV-2-Pandemie: eine Onlinebefragung.

BACKGROUND: The SARS-CoV-2 pandemic has an impact on the wellbeing of health care workers. The influence of a work-related sense of coherence as well as perceived organizational support on the level of burnout and the intention to leave the job is largely unknown, especially for physicians in German hospitals. METHOD: In December 2020 and January 2021, physicians of 81 hospitals in Hessian (Germany) participated in an online survey using the BAT (Burnout Assessment Tool), Work-SoC (Work-related Sense of Coherence), the POS-s (Perceived Organizational SUPPORT - short version) and literature-based items based. RESULTS: Of 181 physicians, 34% showed a moderate or high burnout level, 21% would leave the job after the pandemic. The higher the work-SoC (ß = -0.560; p < 0.001) and the higher the POS-s (ß = -0.125; p < 0.05), the lower the burnout level. Not being able to care sufficiently for their patients has a negative impact on the sense of coherence. 46.4% reported that they did not feel sufficiently prepared by their employer during the pandemic. They wished to have support in the form of the mindfulness and resilience trainings (45%), emergency childcare (41%) and a crisis counselor in their team (32%). CONCLUSION: Regardless of the pandemic, health-promoting work conditions have to be developed that facilitate coherent work and prevent "moral injuries" or enable physicians to deal with them.

[Experiencing leadership in the Corona pandemic in Hessian general hospitals: A descriptive qualitative study]. / Das Erleben der Führungsrolle in der Corona-Pandemie in hessischen Allgemeinkrankenhäusern.

Experiencing leadership in the Corona pandemic in Hessian general hospitals: A descriptive qualitative study Abstract. Background: The second corona pandemic wave is leading to high work demands on the part of nurses and managers of Hessian general hospitals. The associated organizational challenges result in burdens for the managers. Aim: Due to the importance of leaders in securing care structures, this study aims to explore their perception of their leadership role in dealing with the pandemic management. Methods: Telephone qualitative expert interviews with 13 ward and 13 nursing managers of Hessian general hospitals form the basis for the qualitative content analysis that structures the content. Results: To support the nursing staff, the managers choose a personal caring leadership style that also includes the psychosocial needs of the nursing staff. For their part, managers are exposed to high levels of burden, which they counter with professional experience, resilience and an optimistic attitude, among other things. Conclusions: Health-related leadership is essential for maintaining the health of employees. The self care of managers as well as the integration of workplace health promotion into the corporate goal of hospitals should receive more attention for the current and future safeguarding of crisis management.

[Journal clubs in nursing practice: An online survey of German university hospitals]. / Journal Clubs in der Pflegepraxis.

Journal clubs in nursing practice: An online survey of German university hospitals Abstract. Background: Journal clubs (JCs) are an evidence-based method for enabling nursing professionals to develop a scientifically based practice. Research results can be made available to nurses to directly influence their nursing practice. The level of implementation in German university hospitals is currently unknown. Aim: This study surveyed the current state of JCs at German university hospitals. The aim is to develop recommendations for the implementation of JCs for nursing practice. Methods: The online survey of all 27 representatives of the "Network of Nursing Science and Practice Development" of the VPU e.V. was conducted from October to November 2020. The questionnaire was developed based on literature. The data analysis was descriptive. Results: 15 of the 19 clinics surveyed currently implement, or have previously implemented, a JC (response rate 70,4%). In approximately half of the clinics, JC is an established structure that is also offered as part of advanced training and continuing education (46,6%) and is used to develop and expand methodological, scientific competencies (86,6%). Positive experiences, but also structural problems in the implementation of a JC were reported. Approximately one quarter of the clinics evaluate their JC regularly (26,7%). Conclusions: JCs at German university hospitals are currently being established. In order to establish JCs on a permanent basis, EBN knowledge must be continuously imparted in further education and training; in addition, JCs should be an essential component of academic role profiles.

[The situation of nurses in hospitals during the second wave of the COVID-19 pandemic: an online survey]. / Die Situation der Pflegenden in Akutkrankenhäusern während der zweiten Welle der COVID-19-Pandemie.

The situation of nurses in hospitals during the second wave of the COVID-19 pandemic: an online survey Abstract. Background: The COVID-19 pandemic has an impact on stress and wellbeing of nurses. Anxiety of infection, lack of protective equipment and insufficient expertise in care of these patients were described as reasons of burnout. Aim: The influence of work-related sense of coherence as well as perceived organizational support on the burnout level and the intention to leave the job will be explored. Method: In December 2020 and January 2021, staff of 81 hospitals in Hessia, Germany were invited to participate in an online survey using the BAT (Burnout-Assessment-Tool), work-SoC (work-related - Sence of Coherence), the POS-s (perceived organizational Support - short version) and items based on a literature review. Results: Of 595 nurses, 47.6% showed a moderate or high burnout level, 20.7% want to leave the job after the pandemic. The higher the work-SoC (ß = -0.467; p < 0.001) and the higher the POS-s (ß = -0.178; p < 0.001), the lower the burnout level. Trainings in the organization were mentioned by 24.7% of the nurses as a positive factor. They missed support in mindfulness and resilience training, in child care and health-related topics. 55.1% did not agree that the employer does everything to support them. Conclusions: Regardless of the pandemic, salutogenic leadership is required, which deals with "moral injuries" of employees as a result of implicit rationing and foster health-related support.

[Residents with Parkinson's disease in the institutional care : A cross-sectional survey of nursing homes in Germany]. / Bewohner*innen mit Parkinson-Syndrom in der stationären Altenhilfe : Eine Querschnittsbefragung von Wohnbereichsleitungen in Deutschland.

BACKGROUND: The illness trajectory of Parkinson's disease leads to a higher need for care. Little is known about the prevalence of residents with Parkinson's disease in nursing homes, the care situation and the expertise of nurses in these institutions. OBJECTIVE: This study examined the prevalence rate of residents with Parkinson's disease in nursing homes in Germany. In addition, from the subjective point of view of nurse managers, the work of carers, the coordination as well as information and knowledge of the nursing staff were explored. METHOD: The cross-sectional survey of nurse managers from 500 randomized selected nursing homes in Germany was conducted from January to June 2020. The questionnaire used was developed based on the literature. The data were analyzed descriptively. RESULTS: Questionnaires from 85 residential wards in 57 care facilities were analyzed (response rate 11.4%). The prevalence rate of residents with Parkinson's disease was 13.9%. More than a half had a diagnosis of dementia (52.8%). Affected persons received regular treatment and medical consultations. There were no central coordination of care and no specially trained nursing staff. DISCUSSION: Residents with Parkinson's disease are a common occurrence and they show complex symptoms and comorbidities. The frequency of falls with hospital stays and the low number of Parkinson-specific assistive technologies showed that the knowledge of nursing staff can be increased. Central coordination and support for this should be established in long-term care.

[Integrating academic nurses in German university hospitals: a follow-up survey]. / Einbindung von Pflegefachpersonen mit Hochschulabschlüssen an deutschen Universitätskliniken: ein Follow-up-Survey.

INTRODUCTION: The effective integration of professional nursing staff with university training into care processes is associated internationally with better patient outcomes. In Germany, there is a current lack of reliable figures on graduates and their areas of responsibility. Therefore, the aim of this follow-up survey, designed as a repetition of a previous one, was to ascertain the number of nurses with a Bachelor's or Master's degree involved in direct patient care at university medical centers. METHOD: In a cross-sectional study, chief nursing officers in university medical centers were asked to quote the number of professional nurses with a university degree (Bachelor, Master, Doctorate). Additional questions focused on their tasks and responsibilities and the measures undertaken to facilitate their integration into the organization. The data were analyzed using descriptive statistics. RESULTS: In total, n=29 valid questionnaires from 35 university medical centers were included in the analysis, resulting in a response rate of 82.85%. For a total of 18 centers, the number of university-qualified nurses had increased by n=786 between 2015 (n=593) and 2018 (n=1,379). The overall percentage of nurses with a university degree working at a university medical center in the study was 3.16% (SD=1.66; min - max=1.09 - 6.69; Q1 - Q3=1.49 - 4.04; 95% CI 2.30 to 3.95). In direct patient care, the quota was 2.11% (SD=1.40; min - max=0.47 - 5.42; Q1 - Q3=0.87 - 3.16; 95% CI 1.36 to 2.76). The main focus of their duties was on standard care and patient education (graduates with a Bachelor's degree), evidence-based nursing practice development (Master's degree) and research activities (doctoral degree). DISCUSSION: Compared to 2015, the proportion of professional nursing staff with university training has increased but remains at a very low level. These nurses perform relevant clinical tasks and are involved in the development of good practice. However, there is a need for better competence-based differentiation.

Sulfobetaine Hydrogels with a Complex Multilength-Scale Hierarchical Structure.

Hydrogels with a hierarchical structure were prepared from a new highly water-soluble crosslinker N,N,N',N'-tetramethyl-N,N'-bis(2-ethylmethacrylate)-propyl-1,3-diammonium dibromide and from the sulfobetaine monomer 2-(N-3-sulfopropyl-N,N-dimethyl ammonium)ethyl methacrylate. The free radical polymerization of the two compounds is rapid and yields near-transparent hydrogels with sizes up to 5 cm in diameter. Rheology shows a clear correlation between the monomer-to-crosslinker ratio and the storage and loss moduli of the hydrogels. Cryo-scanning electron microscopy, low-field nuclear magnetic resonance (NMR) spectroscopy, and small-angle X-ray scattering show that the gels have a hierarchical structure with features spanning the nanometer to the sub-millimeter scale. The NMR study is challenged by the marked inhomogeneity of the gels and the complex chemical structure of the sulfobetaine monomer. NMR spectroscopy shows how these complications can be addressed via a novel fitting approach that considers the mobility gradient along the side chain of methacrylate-based monomers.

Impact of COVID-19 Pandemic on (Health) Care Situation of People with Parkinson's Disease in Germany (Care4PD).

The Care4PD study examined the impact of the COVID-19 pandemic on the care situation of people (PwP) with Parkinson's disease in Germany. A comprehensive, nationwide, anonymous questionnaire for PwP was distributed by the members' journal of the German Parkinson's Disease Association and in several PD specialized in- and outpatient institutions. PwP subjectively evaluated their general care situation and individual impairments during the pandemic. We analyzed 1269 eligible out of 1437 returned questionnaires (88.3%) and compared PwP with (p-LTC) and without (np-LTC) professional long-term care. Both groups rated the general pandemic-related consequences as being rather mild to moderate (e.g., worsening of symptom or concerns). However, familial/social contact restrictions were indicated as most compromising, whereas access to outpatient professional health care providers was less affected. PwP with professional LTC reported more impairment than those without. COVID-19 vaccination rates and acceptance were generally high (p-LTC: 64.3%, np-LTC: 52.3%) at the time of the study, but realization of sanitary measures-especially wearing masks as a patient during care sessions-still needs to be improved. Technical options for telemedicine were principally available but only rarely used. Altogether, during the COVID-19 pandemic, PwP in Germany seemed to have a relatively stable health care access, at least in outpatient settings, while mainly social isolation compromised them. The p-LTC group was more impaired in everyday live compared with the np-LTC group.

[Prevalence of cognitive impairments in acute nursing care-Analysis and comparison of routine data]. / Prävalenz kognitiver Beeinträchtigungen in der pflegerischen Akutversorgung ­ Analyse und Vergleich von Routinedaten.

BACKGROUND: Due to demographic changes an increasing prevalence of hospitalized patients suffering from cognitive impairments must be assumed. To enable the best possible treatment a routine procedure is necessary to detect this group of patients early on admission. METHOD: The current study assessed the prevalence rate of cognitive impairment in inpatients >65 years who were tested by the mini mental state examination (MMSE) during admission. Based on the screening quota the willingness of nurses to use the MMSE as a routine instrument was tested. The quota was also compared to the number of diagnoses coded as F in the ICD-10-GM. This retrospective study was conducted from October 2018 to March 2019 at a university hospital. RESULTS: Of the 7311 inpatients >65 years, 11.7% were screened. The prevalence of cognitive impairments was 20.7% and was higher than the prevalence rate of dementia and delirium on the basis of medical diagnoses (p <0.001). With only 11.7% the willingness of the nursing staff to use the MMSE to assess cognitive impairments during patient admission was low. CONCLUSION: The higher prevalence confirms the necessity to detect patients with cognitive disorders; however, the low willingness to use the MMSE suggests that a shorter instrument should be used and more information should be provided to nurses about patients with cognitive impairments.

Specialized Staff for the Care of People with Parkinson's Disease in Germany: An Overview.

Access to specialized care is essential for people with Parkinson´s disease (PD). Given the growing number of people with PD and the lack of general practitioners and neurologists, particularly in rural areas in Germany, specialized PD staff (PDS), such as PD nurse specialists and Parkinson Assistants (PASS), will play an increasingly important role in the care of people with PD over the coming years. PDS have several tasks, such as having a role as an educator or adviser for other health professionals or an advocate for people with PD to represent and justify their needs. PD nurse specialists have been established for a long time in the Netherlands, England, the USA, and Scandinavia. In contrast, in Germany, distinct PDS models and projects have been established. However, these projects and models show substantial heterogeneity in terms of access requirements, education, theoretical and practical skills, principal workplace (inpatient vs. outpatient), and reimbursement. This review provides an overview of the existing forms and regional models for PDS in Germany. PDS reimbursement concepts must be established that will foster an implementation throughout Germany. Additionally, development of professional roles in nursing and more specialized care in Germany is needed.

[Prevalence of dementia in university hospitals : Analysis of ICD-10 coding in 5 university hospitals in Germany over a 2-year period]. / Prävalenzen von Demenz in Universitätskliniken : Analyse von ICD-10-Kodierungen in fünf Universitätskliniken in Deutschland über zwei Geschäftsjahre.

BACKGROUND: Demographic changes result in a higher prevalence of patients suffering from dementia in hospital. In Germany, epidemiological data of this target group are scarce and prevalence rates from university hospitals (UH) are not available. The prevalence rates and distribution were analyzed on the basis of ICD-10-GM (German modification) routine data METHOD: A secondary analysis on ICD-10-GM main and secondary diagnoses of dementia from 2014 and 2015 from 5 UH was performed. All patients admitted to hospital for at least 24 h and ≥18 years old (2014 n = 187,168; 2015 n = 189,040) were included. A descriptive analysis for the >69-year-old group was carried out (2014, n = 67,111; 2015; n = 67,824). RESULTS: The 1­year prevalence (2014/2015) for all 5 UH for patients ≥18 years old was 1.3%/1.4% and for the >69-year-old group, 3.3%/3.5%. The prevalence rates between the five UH varied: for patients ≥18 years the range was 0.44-2.16% (2014) and 0.44-2.77% (2015) and for >69-year-olds 1.16-5.52% (2014) and 1.16-7.06% (2015). Most cases were correlated with major diagnostic categories of traumatology, cardiology, gastroenterology and neurology. CONCLUSION: Analysis of ICD-10-GM routine data can provide an indication of the prevalence of dementia in UH. Results of the >69-year-olds varied greatly between participating UH. The reasons for this might be different healthcare tasks, especially with respect to geriatric patients; however, it is also possible that assessment procedures are not standardized and unreliable and therefore the coding is invalid. A standardized procedure for the identification of people suffering from dementia is necessary.

[Status and development of the role as Parkinson Nurse in Germany - an online survey]. / Stand und Entwicklung der Rolle als Parkinson Nurse in Deutschland ­ Eine Online-Befragung.

Status and development of the role as Parkinson Nurse in Germany - an online survey Abstract. BACKGROUND: In Germany there is a course for Parkinson Nurses (PN) since 2006. Content, structure and organization of their tasks have not yet been systematically described for Germany. AIM: How is the typical working day of PN organised in Germany? Which tasks do they have? Which conditions are promoting or inhibiting for their work? METHODS: Among the graduates of the course, an online survey was conducted from September to November 2016. 39 questionnaires were analysed descriptively (response rate 34 %). RESULTS: 52 % of PN work in specialist hospitals and 26 % work in hospitals of maximum medical care. Only 29 % work according to a concept and only 23 % have a job description. 21 % of respondents no longer work as PN. Counselling and education, information on medication management, educational advertising on Parkinson' disease as well as training of other professionals are at the centre of their work. The activities usually focus the work in the institution; a trans-sectoral support for people with Parkinson's disease is rare. CONCLUSIONS: In the future, concepts and job descriptions should be stored in the institutions, which are oriented towards a cross-institutional orientation framework. On the basis of a common understanding of roles it is possible to facilitate networking of the PN as well as the co-operation with other specialists. The curriculum at an academic level leads to the necessary competencies.

Anionic Polymer Brushes for Biomimetic Calcium Phosphate Mineralization-A Surface with Application Potential in Biomaterials.

This article describes the synthesis of anionic polymer brushes and their mineralization with calcium phosphate. The brushes are based on poly(3-sulfopropyl methacrylate potassium salt) providing a highly charged polymer brush surface. Homogeneous brushes with reproducible thicknesses are obtained via surface-initiated atom transfer radical polymerization. Mineralization with doubly concentrated simulated body fluid yields polymer/inorganic hybrid films containing AB-Type carbonated hydroxyapatite (CHAP), a material resembling the inorganic component of bone. Moreover, growth experiments using Dictyostelium discoideum amoebae demonstrate that the mineral-free and the mineral-containing polymer brushes have a good biocompatibility suggesting their use as biocompatible surfaces in implantology or related fields.

Poly(ethylene oxide)-b-poly(3-sulfopropyl methacrylate) block copolymers for calcium phosphate mineralization and biofilm inhibition.

Poly(ethylene oxide) (PEO) has long been used as an additive in toothpaste, partly because it reduces biofilm formation on teeth. It does not, however, reduce the formation of dental calculus or support the remineralization of dental enamel or dentine. The present article describes the synthesis of new block copolymers on the basis of PEO and poly(3-sulfopropyl methacrylate) blocks using atom transfer radical polymerization. The polymers have very large molecular weights (over 10(6) g/mol) and are highly water-soluble. They delay the precipitation of calcium phosphate from aqueous solution but, upon precipitation, lead to relatively monodisperse hydroxyapatite (HAP) spheres. Moreover, the polymers inhibit the bacterial colonization of human enamel by Streptococcus gordonii, a pioneer bacterium in oral biofilm formation, in vitro. The formation of well-defined HAP spheres suggests that a polymer-induced liquid precursor phase could be involved in the precipitation process. Moreover, the inhibition of bacterial adhesion suggests that the polymers could be utilized in caries prevention.

[The situation of people suffering from Parkinson's disease and their relatives in the mirror of literature - an overview]. / Die Lebenssituationen Parkinsonbetroffener und deren Angehörigen im Spiegel der Literatur - ein Uberblick.

Despite of new therapy methods there currently is no perspective for healing or stopping the course of Parkinson's disease. Because of this and the predicted increase of the number of people suffering from parkinsonian syndromes, not only medical care but also nursing care of these syndromes will be of high importance in the future. The main objective of the conducted review was to study professional literature describing the situation of affected people and their relatives allowing to derive the appropriate requirements for a suitable care environment. This systematic review was conducted in the databases PubMed, CINAHL, Embase and Cochrane Library of Systematic Reviews. The results were considered with the focus of two main issues of a social situation (Dreitzel, 1972), the themes and the partners of interaction. The themes were assigned according to the coping needs of Corbin and Strauss (2004). Those needs can be observed during the progression of a chronic disease. Given the basic coping needs of affected people in different life situations, the results of 41 surveys and articles demonstrate the need for a continuous support of people suffering from parkinsonian syndromes and their relatives. Described are central issues such as financial coverage, maintenance of the individual role, getting support in dealing with the diagnosis and experiencing acceptance of one's perception of physical symptoms by health professionals. The professional life, family life, personal relationships, physician-patient and nurse-patient relationships, parent-child relationships as well as being part of society are described to be particularly challenging. The importance of support by a specialised nurse within the meaning of a Parkinson's Disease Nurse Specialist is being discussed.