Intervention for sleep problems in nursing home residents with dementia: a cluster-randomized study.

OBJECTIVE: To reduce sleep problems in people living with dementia using a multi-component intervention. DESIGN: Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks. SETTING: Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants). PARTICIPANTS: Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH. INTERVENTION: The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two "sleep nurses," (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care. MEASUREMENTS: Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI). RESULTS: Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of -24.5% (95% CI, -46.3% - -2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087-0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks. CONCLUSIONS: The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.

Item distribution, internal consistency and structural validity of the German language person-centred climate questionnaire - staff version (PCQ-G-S): a cross-sectional study.

BACKGROUND: Person-centredness is considered as best practice for people living with dementia. A frequently used instrument to assess person-centredness of a care environment is the Person-centred Climate Questionnaire (PCQ). The questionnaire comprises of 14 items with the three subscales a climate of safety, a climate of everydayness and a climate of community. AIM: The aim of the study is to describe the translation process of the English language Person-centred Climate Questionnaire (Staff version, Patient version, Family version) into German language (PCQ-G) and to evaluate the first psychometric properties of the German language Person-centred Climate Questionnaire- Staff version (PCQ-G-S). METHODS: We conducted a cross-sectional study. The three versions of the 14-item English PCQ were translated into German language (PCQ-G) based on the recommendations for cross-cultural adaption of measures. Item distribution, internal consistency and structural validity of the questionnaire were assessed among nursing home staff (PCQ-G-S). Item distribution was calculated using descriptive statistics. Structural validity was tested using principal component analysis (PCA), and internal consistency was assessed for the resulting subscales using Cronbach's alpha. Data collection took place from May to September 2021. RESULTS: A total sample of 120 nurses was included in the data analysis. Nine out of 14 items of the PCQ-G-S demonstrated acceptable item difficulty, while five times showed a ceiling effect. The PCA analysis demonstrated a strong structural validity for a three-factor solution explaining 68.6% of the total variance. The three subscales demonstrated a good internal consistency with Cronbach's alpha scores of 0.8 for each of the subscales. CONCLUSION: The analysis of the 14-item German version (PCQ-G-S) showed first evidence for a strong internal consistency and structural validity for evaluating staff perceptions of the person-centredness in German nursing homes. Based on this, further investigations for scale validity of the PCQ-G versions should be carried out.

Non-pharmacological interventions for sleep disturbances in people with dementia.

BACKGROUND: Sleep disturbances occur frequently in people with dementia with a reported prevalence of up to 40%. Common problems are increased number and duration of awakenings and increased percentage of light sleep. Sleep disturbances are associated with a number of problems for people with dementia, their relatives, and carers. In people with dementia, they may lead to worsening of cognitive symptoms, challenging behaviours such as restlessness or wandering, and further harms, such as accidental falls. Sleep disturbances are also associated with significant carer distress and have been reported as a factor contributing to institutionalisation of people with dementia. As pharmacological approaches have shown unsatisfactory results, there is a need to synthesise the research evidence on non-pharmacological strategies to improve sleep in people with dementia. As interventions are often complex, consisting of more than one active component, and implemented in complex contexts, it may not be easy to identify effective intervention components. OBJECTIVES: To evaluate the benefits and harms of non-pharmacological interventions on sleep disturbances in people with dementia compared to usual care, no treatment, any other non-pharmacological intervention, or any drug treatment intended to improve sleep, and to describe the components and processes of any complex intervention included. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search was 13 January 2022. SELECTION CRITERIA: We included individually or cluster-randomised controlled trials in people with dementia comparing non-pharmacological interventions to improve sleep compared to usual care or to other interventions of any type. Eligible studies had to have a sleep-related primary outcome. We included people with a diagnosis of dementia and sleep problems at baseline irrespective of age, type of dementia, severity of cognitive impairment, or setting. Studies reporting results on a mixed sample (e.g. in a nursing home) were only considered for inclusion if at least 80% of participants had dementia. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. objective sleep-related outcomes (e.g. total nocturnal sleep time, consolidated sleep time at night, sleep efficiency, total wake time at night (or time spent awake after sleep onset), number of nocturnal awakenings, sleep onset latency, daytime/night-time sleep ratio, night-time/total sleep ratio over 24 hours) and 2. ADVERSE EVENTS: Our secondary outcomes were 3. subjective sleep-related outcomes, 4. behavioural and psychological symptoms of dementia, 5. quality of life, 6. functional status, 7. institutionalisation, 8. compliance with the intervention, and 9. attrition rates. We used GRADE to assess the certainty of evidence and chose key outcomes to be included in summary of findings tables. MAIN RESULTS: We included 19 randomised controlled trials with 1335 participants allocated to treatment or control groups. Fourteen studies were conducted in nursing homes, three included community residents, one included 'inpatients', one included people from a mental health centre, and one included people from district community centres for older people. Fourteen studies were conducted in the US. We also identified nine ongoing studies. All studies applied one or more non-pharmacological intervention aiming to improve physiological sleep in people with dementia and sleep problems. The most frequently examined single intervention was some form of light therapy (six studies), five studies included physical or social activities, three carer interventions, one daytime sleep restriction, one slow-stroke back massage, and one transcranial electrostimulation. Seven studies examined multimodal complex interventions. Risk of bias of included studies was frequently unclear due to incomplete reporting. Therefore, we rated no study at low risk of bias. We are uncertain whether light therapy has any effect on sleep-related outcomes (very low-certainty evidence). Physical activities may slightly increase the total nocturnal sleep time and sleep efficiency, and may reduce the total time awake at night and slightly reduce the number of awakenings at night (low-certainty evidence). Social activities may slightly increase total nocturnal sleep time and sleep efficiency (low-certainty evidence). Carer interventions may modestly increase total nocturnal sleep time, may slightly increase sleep efficiency, and may modestly decrease the total awake time during the night (low-certainty evidence from one study). Multimodal interventions may modestly increase total nocturnal sleep time and may modestly reduce the total wake time at night, but may result in little to no difference in number of awakenings (low-certainty evidence). We are uncertain about the effects of multimodal interventions on sleep efficiency (very low-certainty evidence). We found low-certainty evidence that daytime sleep restrictions, slow-stroke back massage, and transcranial electrostimulation may result in little to no difference in sleep-related outcomes. Only two studies reported information about adverse events, detecting only few such events in the intervention groups. AUTHORS' CONCLUSIONS: Despite the inclusion of 19 randomised controlled trials, there is a lack of conclusive evidence concerning non-pharmacological interventions for sleep problems in people with dementia. Although neither single nor multimodal interventions consistently improved sleep with sufficient certainty, we found some positive effects on physical and social activities as well as carer interventions. Future studies should use rigorous methods to develop and evaluate the effectiveness of multimodal interventions using current guidelines on the development and evaluation of complex interventions. At present, no single or multimodal intervention can be clearly identified as suitable for widespread implementation.

Experiences with long-term care for geriatric patients by an interprofessional outpatient care approach - a qualitative study.

BACKGROUND: Outpatient care for geriatric patients is complex and requires the collaboration of different professions for supporting long-term care. Care and case management (CCM) could provide support with that. The long-term care of geriatric patients could be optimized with an interprofessional, cross-sectoral CCM. Therefore, the aim of the study was to evaluate the experiences and attitudes of those involved in the care with regard to the interprofessional design of the care for geriatric patients. METHODS: A qualitative study design was used. Focus group interviews were conducted with those involved in the care (general practitioners (GP), health care assistants (HCA) as well as care and case managers (CM)). The interviews were digitally recorded, transcribed and analysed by qualitative content analysis. RESULTS: Overall, ten focus groups were conducted in the five practice networks with n = 46 participants (n = 15 GP, n = 14 HCA and n = 17 CM). The participants evaluated the care they received from a CCM positively. The HCA and the GP were the primary points of contact for the CM. The close collaboration with the CM was experienced to be rewarding and relieving. Through their home-visitations, the CM gained a deep insight into the homelives of their patients and were thus able to accurately reflect the gaps in the care back to the family physicians. CONCLUSIONS: The different health care professionals involved in this type of care experience that an interprofessional and cross-sectoral CCM is able to optimally support the long-term care of geriatric patients. The different occupational groups involved in the care benefit from this type of care arrangement as well.

Attitudes and knowledge of nurses working at night and sleep promotion in nursing home residents: multicenter cross-sectional survey.

BACKGROUND: Sleep disturbances are common in nursing home residents and challenging for their nurses. Knowledge about sleep and sleep promoting factors is essential to provide adequate sleep management, where nurses play a key role. Therefore, nurses' knowledge and attitudes towards sleep and sleep promoting interventions is important as enabling or inhibiting factor for successful sleep management. METHODS: A multicenter cross-sectional study was conducted among nurses working wholly or partially at night in nursing homes in Germany. Data were collected between February and April 2021 via online or paper and pencil questionnaires, comprising 56 items. Nursing homes were recruited through existing cooperation with the study centers as well as via nursing home registers. RESULTS: Finally, 138 nursing homes participated and 271 nurses completed the survey. Nurses agreed that sleep disturbances are an important topic with important impact on resident' health. Although, the assessment of sleep was seen as nurses' responsibility, only 40 nurses (14.7%) stated that residents' sleep was always documented. Only 21.7% reported the availability of policy documents providing guidance regarding the management of sleep disturbances. The vast majority (93.2%) reported never having received training about sleep and management of sleep disturbances after their basic nursing training. CONCLUSIONS: Our results indicate that nurses working at night can play an important role in residents' sleep promotion. The findings indicate nurses' educational needs regarding sleep and sleep promotion. Nursing homes should implement institutional guidelines in order to promote residents' sleep based on adequate evidence-based non-pharmacological interventions.

Specifics of and training needs in the inter-professional home care ofpeople with dementia.

Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.

[A case management questionnaire for family caregivers of geriatric patients]. / Ein Case-Management-Fragebogen für Angehörige geriatrischer Patienten.

BACKGROUND: To ease the burden for family caregivers healthcare concepts are urgently needed. The healthcare concept continuous care in a regional network (RubiN) offers a care and case management in physician networks for geriatric patients and aims to relieve family caregivers. The aim of the study was to develop and to test the psychometric properties of a questionnaire that evaluates the satisfaction and acceptance of the healthcare provided by case management (CM) from the perspective of family caregivers. METHODS: A mixed methods design was used to develop the questionnaire based on qualitative interviews, a literature search and own project experiences. After a pilot run the subsequent data acquisition took place in the participating RubiN physician networks from May to August 2020. Each of the 5 participating networks received a set of 50 questionnaires for family caregivers. The psychometric properties of the questionnaire were evaluated. RESULTS: The questionnaire consisted of 11 items. A total of 137 family caregivers participated in the survey (response rate 55%). Overall, the family caregivers were very satisfied (78.1%) with the care offered. There were only a few missing values in the data. The 11 items in the questionnaire loaded on 2 factors. The first factor called effects from coordination showed an internal consistency of 0.843 and for the second factor called accessibility an internal consistency of 0.683 was observed. CONCLUSION: The questionnaire with 11 items is characterized by its brevity and includes the acceptance and satisfaction of the care elements offered for family caregivers in a geriatric CM.

Characteristics of multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents: a systematic review.

BACKGROUND: Dementia guidelines propose the use of nonpharmacological interventions for sleep disturbances for older people. Based on available reviews, it seems most likely that multicomponent interventions have the strongest potential to be effective in improving sleep. However, a detailed description of multicomponent interventions is missing. This systematic review aims to identify, describe, and summarize multicomponent, nonpharmacological interventions to reduce or avoid sleep disturbances in nursing home residents. METHODS: This review followed established methodological frameworks for systematic evidence syntheses. A computerized search was conducted in December 2018, using the databases PubMed, CINAHL, Scopus, and Cochrane Library. Two independent reviewers assessed all search results to identify eligible studies and assessed studies' methodological quality following the Cochrane Risk of Bias methodology for randomized controlled trials and the CASP Appraisal Checklist for controlled trials.Evaluation studies of any design investigating multicomponent interventions were included, except case studies. Components of included intervention programs were analyzed applying the TIDieR and CReDECI 2 criteria. RESULTS: A total of 2056 studies were identified through the database search; ten publications about nine interventions met the inclusion criteria and were included in the review. The identified interventions can be summarized assigned to the categories "daytime activities," "nighttime activities," "staff training," and "light exposure." The approaches showed similarities and differences in procedures, materials, modes of delivery, intervention provider, and intervention period. None of the studies described any intended interactions between components or considered context characteristics in intervention modeling as well as internal and external facilitators or barriers influencing delivery of intervention. We identified positive or mixed positive effects for sleep-related outcomes for the mentioned categories. CONCLUSIONS: The analysis of included interventions demonstrates somehow promising results, although findings are difficult to interpret as interventions were not well described, and the challenges of developing and evaluating complex interventions were not sufficiently acknowledged.

Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial.

BACKGROUND: Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no "gold standard" intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. METHODS: This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two "sleep nurses" as change agents per nursing home, (3) a basic education course for nursing staff: "Sleep problems in dementia", (4) an advanced education course for nursing staff: "Tailored problem-solving" (two workshops), (5) workshops: "Development of an institutional sleep-promoting concept" (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and "One Minute Wonder" poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. CONCLUSIONS: It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. TRIAL REGISTRATION: Current controlled trials: ISRCTN36015309 . Date of registration: 06/11/2020.

Nurses' burden caused by sleep disturbances of nursing home residents with dementia: multicenter cross-sectional study.

BACKGROUND: Sleep disturbances are common in people with dementia. In nursing homes, this is frequently associated with residents' challenging behavior and potentially with nurses' burden. This study examined nurses' burden associated with nursing home residents' sleep disturbances. METHODS: A multicenter cross-sectional study was conducted. Nurses' burden associated with residents' sleep disturbances was assessed using the Sleep Disorder Inventory (SDI). Additionally, the proportion of nurses' total burden associated with sleep disturbances of residents with dementia was assessed. A linear mixed regression model was used to investigate the association with nurses', residents' and institutional characteristics. RESULTS: One hundred eleven nurses from 38 nursing homes were included. 78.4% stated to be regularly confronted with residents' sleep disturbances during nightshifts, causing distress. The mean proportion of nurses' total burden caused by residents' sleep disturbances was 23.1 % (SD 18.1). None of the investigated characteristics were significantly associated with nurses' total burden. CONCLUSIONS: Nurses report burden associated with sleep disturbances as common problem. There is a need to develop effective interventions for sleep problems and to train nurses how to deal with residents' sleep disturbances.

Quality of health care for refugees - a systematic review.

OBJECTIVE: The aim of this systematic review was to identify quality indicators (QI) developed for health care for refugees. METHODS: We conducted a systematic review of international QI databases such as the Agency for Health care Research and Quality in addition to a systematic search in PubMed, Cochrane library and Web of Science, using the terms "refugee" and "quality indicator", complemented by a search in reference lists and grey literature. All papers which included QIs for refugees, especially for health care were included. In a first step all existing QIs were screened for their relevance to refugees. In a second step, all health care QIs were extracted. In a final step, these health care QIs were classified into process, structure and outcome indicators. RESULTS: Of 474 papers, 23 were selected for a full-text review. Of these 23 publications, 6 contained 115 QIs for health and health care for refugees. The main health care topics identified were reproductive health, health care service and health status. CONCLUSIONS: Most indicators were indicators for outcome and structure quality, the smallest group were process indicators. Within the area of refugee health care, most QIs that have been found were QIs regarding reproductive health. QI databases do not yet include indicators specifically related to refugees.

Are big data analytics helpful in caring for multimorbid patients in general practice? - A scoping review.

BACKGROUND: The treatment of multimorbid patients is one crucial task in general practice as multimorbidity is highly prevalent in this setting. However, there is little evidence how to treat these patients and consequently there are but a few guidelines that focus primarily on multimorbidity. Big data analytics are defined as a method that obtains results for high volume data with high variety generated at high velocity. Yet, the explanatory power of these results is not completely understood. Nevertheless, addressing multimorbidity as a complex condition might be a promising field for big data analytics. The aim of this scoping review was to evaluate whether applying big data analytics on patient data does already contribute to the treatment of multimorbid patients in general practice. METHODS: In January 2018, a review searching the databases PubMed, The Cochrane Library, and Web of Science, using defined search terms for "big data analytics" and "multimorbidity", supplemented by a search of grey literature with Google Scholar, was conducted. Studies were not filtered by type of study, publication year or language. Validity of studies was evaluated independently by two researchers. RESULTS: In total, 2392 records were identified for screening. After title and abstract screening, six articles were included in the full-text analysis. Of those articles, one reported on a model generated with big data techniques to help caring for one group of multimorbid patients. The other five articles dealt with the analysis of multimorbidity clusters. No article defined big data analytics explicitly. CONCLUSIONS: Although the usage of the phrase "Big Data" is growing rapidly, there is nearly no practical use case for big data analysis techniques in the treatment of multimorbidity in general practice yet. Furthermore, in publications addressing big data analytics, the term is rarely defined. However, possible models and algorithms to address multimorbidity in the future are already published.

How Do Health Care Professionals Perceive a Holistic Care Approach for Geriatric Patients? A Focus Group Study.

BACKGROUND: Geriatric patients require holistic care in order to meet their complex care needs. The project RubiN (Continuous Care in a Regional Network) provides case and care management (CCM) for older people to address these needs in a primary care setting in Germany. This study aimed to explore the experiences of health care professionals who provided CCM for geriatric patients. METHODS: Focus group interviews with general practitioners (GPs), health care assistants (HCAs), and case managers (CMs) were conducted. Transcribed data were analyzed by using qualitative content analysis. RESULTS: Ten focus group discussions (n = 15 GPs, n = 14 HCAs, n = 17 CMs) were conducted. The different health care professionals emphasized the importance of a holistic care approach to geriatric care. Moreover, the GPs stated that the CMs supported the patients in organizing their care. A CCM could help encourage patients to remain at their own homes, which would have an effect on patients' quality of life and satisfaction. CONCLUSION: A well-functioning and effective cooperation between those health professionals involved is a prerequisite for a trustful relationship in the holistic care of older people. This creates a feeling of security for all people involved in the care process.

Experiences of family caregivers regarding a community-based care- and case-management intervention. A qualitative study.

Family caregivers play an essential role in healthcare for elderly people in primary care settings. The complexity of geriatric patients as well as the fragmentation of healthcare systems can lead to a burden for family caregivers, which can affect their physical and psychological health as well as social relationships, economic productivity and quality of caregiving. Care- and case-management offers a possibility to support, empower and navigate family caregivers through healthcare systems in order to reduce their own burden. The project RubiN (Continuous care in a regional network) was developed to provide regional care- and case-management for outpatient care of the elderly (age >70 years) in a primary care setting in Germany. The aim of this qualitative study was to explore experiences and attitudes of family caregivers of geriatric patients regarding the community-based care- and case-management intervention RubiN. Telephone interviews with a purposeful sample of 21 family caregivers enlisted in all RubiN networks were conducted between March and May 2020 and were followed by qualitative content analysis. The main categories, which emerged were namely: (1) current healthcare situation and (2) experiences with RubiN. Main findings suggest that participants in this study valued the provided support and experienced a sense of relief. However, some participants were disappointed with RubiN and the included support by care- and case-managers. A care- and case-management affected caregiving per se as well as the patient's and family caregiver's well-being. Important aspects contributing to these findings were a continuous relationship, training and expertise of the care- and case-managers. Establishing networks between the patients, family caregivers, care- and case-managers and healthcare providers were key components as well as a good explanation about RubiN itself for family caregivers. Therefore, a community-based care- and case-management can play an important role in detecting, facilitating and preventing family caregiver burden.

Evidence for foot orthoses for adults with flatfoot: a systematic review.

BACKGROUND: Flatfoot is characterised by the falling of the medial longitudinal arch, eversion of the hindfoot and abduction of the loaded forefoot. Furthermore, flatfoot leads to a variety of musculoskeletal symptoms in the lower extremity, such as knee or hip pain. The standard conservative treatment for flatfoot deformity is exercise therapy or treatment with foot orthoses. Foot orthoses are prescribed for various foot complaints. However, the evidence for the provision of foot orthoses is inconsistent. The aim of this systematic review is to synthesize the evidence of foot orthoses for adults with flatfoot. METHODS: A computerized search was conducted in August 2021, using the databases PubMed, Scopus, Pedro, Cochrane Library, and the Cochrane Central Register of Controlled Trials. Intervention studies of any design investigating the effects of foot orthoses were included, apart from case studies. Two independent reviewers assessed all search results to identify eligible studies and to assess their methodological quality. RESULTS: A total of 110 studies were identified through the database search. 12 studies met the inclusion criteria and were included in the review. These studies investigated prefabricated and custom-made foot orthoses, evaluating stance and plantar pressure during gait. The sample sizes of the identified studies ranged from 8 to 80. In most of the studies, the methodological quality was low and a lack of information was frequently detected. CONCLUSION: There is a lack of evidence on the effect of foot orthoses for flatfoot in adults. This review illustrates the importance of conducting randomized controlled trials and the comprehensive development of guidelines for the prescription of foot orthoses. Given the weak evidence available, the common prescription of foot orthoses is somewhat surprising.

"I Have Such a Great Care" - Geriatric Patients' Experiences with a New Healthcare Model: A Qualitative Study.

PURPOSE: Coordinated care is important for the health and well-being of geriatric patients. However, continuity of care is lacking in many countries. Several studies have shown that case management can help to meet these requirements in health care and investigated positive effects. The project RubiN (Regional ununterbrochen betreut im Netz; Continuous care in a regional network) was developed to provide regional care- and case management for outpatient care of the elderly (age >70 years) in a primary care setting. The aim of this qualitative approach was to explore experiences and attitudes of geriatric patients towards the newly developed complex care- and case-management intervention RubiN. PATIENTS AND METHODS: Qualitative interviews with a purposive sample of geriatric patients enlisted in the RubiN intervention networks were conducted. The collected data was transcribed and evaluated using qualitative content analysis. A deductive-inductive approach was used in generating thematic categories. RESULTS: Forty-four telephone interviews were performed. Two key categories were identified to describe patients' experiences regarding care delivered by a care- and case manager (CCM), namely "role of CCM" and "changes through RubiN". Results demonstrated that care performed by CCMs is perceived positively by geriatric patients. A main finding of this study was that geriatric patients experienced a sense of security through the care provided by CCMs. CCMs were perceived as highly competent people, having all the necessary skills to provide continuity of care. CONCLUSION: This study illustrates the importance of trust between care provider and care recipient. It also shows that geriatric patients appreciate the continuous, professional care and structural and functional support provided by qualified CCMs.

[Telemedicine projects in rural areas of Germany. A systematic evaluation with the "Model for Assessment of Telemedicine"]. / Telemedizinprojekte im ländlichen Raum Deutschlands. Eine systematische Bewertung mit dem "Modell zur Evaluation von telemedizinischen Anwendungen".

BACKGROUND: The term telemedicine describes the delivery of healthcare services through the use of information and communication technologies in a situation where the actors are at different locations. While telemedical applications are piloted in research projects in Germany, they have rarely become part of everyday care. In order to find indications as to why the transfer of knowledge into practice has so far been slow, it is necessary to examine telemedical projects for aspects of implementation science. METHODS: A systematic search looking for telemedical projects in Germany was conducted in the electronic databases PubMed, Web of Science and ACM Digital Library using a complex search strategy. The criteria and domains of the Model for Assessment of Telemedicine (MAST) were used to evaluate the publications. RESULTS: A total of 336 publications were identified, 16 of which were ultimately included in the analysis. Much of the work deals with stroke and the implementation of telemedicine networks. The analysis according to MAST shows that most publications omit essential considerations. CONCLUSION: Publications on telemedical projects are often characterized by unsystematic approaches. The MAST instrument identifies areas where the approaches to telemedical projects could be extended in the future to ensure the sustainability and feasibility of these prototypical telemedical applications.

Prevalence of Sleep Disturbances in German Nursing Home Residents with Dementia: A Multicenter Cross-Sectional Study.

BACKGROUND: Sleep disturbances and insomnia occur frequently in people with dementia and are associated with a number of problems for affected persons, relatives, and carers. OBJECTIVE: Considering the lack of high-quality data especially from Germany, this study aimed to determine the prevalence of sleep disturbances and possible associated factors with in German nursing home residents. METHODS: Multicenter cross-sectional study. Nursing homes in Northern Germany were randomly selected from nursing home registers and contacted consecutively. All residents with cognitive impairment living in the nursing homes were included. Data collection took place between June and December 2017. In addition to the characteristics of nursing homes, nurses, and residents, sleep disturbances of residents with dementia were assessed using the Sleep Disorder Inventory (SDI). Descriptive statistics were applied for prevalence assessment. A generalized linear mixed model was used to investigate associated factors. RESULTS: 38 nursing homes and 1,187 residents with cognitive impairment were included in the study. Sleep disturbances were reported for 23% of residents with pronounced differences between centers, ranging from 0-85%. The prescription of psychotropic drugs (OR 4.47; 95% CI 3.06-6.43; p < 0.01), residence at a specialized dementia care unit (OR 2.43; 95% CI 1.30-4.53; p < 0.01), and male sex (OR 1.56, 95% CI 1.08-2.25, p < 0.02) were significantly associated with sleep problems. CONCLUSIONS: In Germany, prevalence of sleep disturbances in people with dementia is comparable to reports from other countries. Therefore, the development and rigorous evaluation of preferably non-pharmacological interventions is strongly warranted.