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.

Bessere Wissensaufnahme durch Kurzfortbildungen vor dem Spätdienst statt nach dem Frühdienst?

Better knowledge absorption of short training courses before late shift than after early shift? An observational study Abstract. Introduction: Further training for nurses on intensive care units (ICU) is obligatory, but there is a lack of short-term options of up to 15 minutes during working time. Currently data for optimal positioning of short-term further training courses for nurses in ICU is not available. Question: What are the effects of short-term further trainings before late shift compared to after early shift on the knowledge acquisition of nurses in ICU? In addition, further framework conditions and a final recommendation for the events should be determined. Methods: Data was collected as an observational study with one group of nurses who took part in a 15-minute further training course at the start of the late shift (VS) and another who attended these at the end of the early shift (VF). A self-created questionnaire was used. The Odds Ratio (OR) was calculated as primary outcome using three questions. Secondary outcome parameters like punctual participation of the nurses, but also a final recommendation behavior counted were determined using methods of descriptive statistics. Results: With a response rate of 98.59% (n = 420), the overall OR was 1.22 (95%-KI: 0.90; 1.64) in favor of the VS group compared to VF. 96.73% (n = 237) of nurses in group VS and 80.13% (n = 121) in VF were able to attend further trainings in time. Participants recommended the short training courses on a scale of 1 (definitely go) to 6 (prefer to stay) in VS with an arithmetic average of 2.27 (SD 1.15) and in VF with 2.21 (SD 1.07). Conclusion: Short further training courses should be offered at the beginning of the late shift.

Hygiene trained nursing staff at wards ­ What can this additional educated nurses achieve? / Hygienebeauftragte in der Pflege auf den Stationen. Erste Erfahrungen zur Einführung im Universitätsklinikum Köln

Background: Hygiene deficits can cause hospital-acquired infections. To meet this public health problem the Robert Koch-Institute advocates the employment of infection control link nurses (ICLN). Aim: This study aimed to evaluate the experiences of ICLNs working in the University Hospital of Cologne. Method: A cross-sectional survey of all ICLNs (n = 64) working at the University Hospital of Cologne was carried out by a self developed questionaire. The data were assessed descriptively. Results: The return rate was 45.3 % (n = 29). The ICLNs were very satisfied with the ICLN training and felt well prepared for their task. The collaboration with other nursing staff, their head nurse and the Department of Hygiene was also positively evaluated. However, only one third of the respondents was satisfied with their working conditions and only half of them indicated feeling that the efforts they made so far were successful. This study also found that, many of the legal intended services were rarely performed. The study identified two barriers to implementation of ICLNs. On the one hand, the release from other routine nursing duties and on the other hand a lack of acceptance of the role by physicians. Conclusions: The task ahead is to find ways to exempt ICLNs from other duties and to involve the physicians more intensely in the implementation of ICLNs.

[Pilot survey on continuing education for pharmacists in Germany]. / Piloterhebung zur Fortbildungssituation der Apotheker*innen in Deutschland.

INTRODUCTION: Continuing education (CE) for pharmacists is mandatory in Germany. However, the findings on CE activities of pharmacists are limited. The aim of this study was to conduct a pilot survey on the CE situation of pharmacists in Germany, including licensed and future pharmacists, to determine the commitment to CE, the attitude towards CE and an obligation to provide evidence, the extent of CE considered necessary and the application of CE content in professional practice. METHODS: A cross-sectional study was conducted in the form of an online survey using SoSci survey, which was addressed to licensed pharmacists, pre-registration pharmacists, and pharmacy students. The online survey was promoted by pharmaceutical professional societies, trade media and interest groups. RESULTS: In total, 880 participants were included in the study: 695 pharmacists, 136 pharmacy students and 49 pre-registration pharmacists. Only 50.0% of the participants were aware of their CE obligations. Among the pharmacists, 44.9% reported that they held the voluntary advanced training certificate issued by the Chambers of Pharmacists. 551 participants reported the CE points of the past twelve month. On average, 56.2 ±â€¯50.2 CE points were collected (x̅ = 210.8 CE minutes per month). Pharmacists not holding the voluntary advanced training certificate of the Chamber of Pharmacists collected significantly fewer (p < 0.001) CE points (39.5 ±â€¯32.0 points; x̅ = 148.1 CE minutes per month). On average, the study population considered a minimum number of 33.9 ±â€¯20.9 CE points per year (x̅ = 127.1 CE minutes per month) to be adequate to meet the CE requirements. DISCUSSION: Although the majority participated in CE, the introduction of nationwide CE commitment monitoring was rejected. On the one hand, this may be linked to a lack of willingness to engage in lifelong learning. On the other hand, it should be borne in mind that, despite the same common nationwide legal basis, the different Chambers of Pharmacists districts have set up different rules concerning the minimum yearly CE commitment, the proof of compliance with CE requirements and fines for non-compliance. Therefore, the introduction of nationwide standard regulations may result in a greater acceptance of CE commitment checks. CONCLUSION: Pharmacists' willingness to CE participation has so far been dependent on intrinsic motivation. Although many licensed pharmacists were in possession of the advanced training certificate issued by the Chambers of Pharmacists, the majority of participants did not support the introduction of a nationwide CE commitment monitoring. 127.1 CE minutes per month were considered appropriate to fulfill the CE obligations, which is significantly less than the 187.5 CE minutes per month which are required to obtain the advanced training certificate of the Chambers of Pharmacists.

[Climate change and child health: A nationwide survey among paediatricians in Germany]. / Klimawandel und Kindergesundheit: eine bundesweite Befragung von Pädiater*innen in Deutschland.

BACKGROUND: Children are a vulnerable group affected by climate change. Paediatricians are important actors in protecting children from climate change-related health risks and in identifying and treating relevant health effects. The main objectives of this study were to determine how paediatricians assess the relevance of climate change-related health impacts, through which channels paediatricians can be reached most effectively, how often climate change-specific prevention measures are implemented and how they are assessed. METHODS: Between February and July 2020, an online survey was conducted among paediatricians. The cross-sectional survey was designed to gather knowledge and attitudes about the relevance of climate change, sources of information and prevention measures. All participants who answered only one question or none at all were excluded. Differences between groups were determined using one-factorial analysis of variance. Correlations were determined using Pearson's bivariate correlation analysis and tested for two-sided significance. RESULTS: A total of 408 questionnaires were analysed. Over 95% of the respondents were paediatricians, with just under half of them working in children's hospitals and a good third in paediatric practices. According to paediatricians, climate change has a relevant impact on children's health. The most significant effects on children's health were considered to be longer and stronger pollen seasons, neophytes and neozoa, Lyme disease and TBE (tick-borne encephalitis, summer meningoencephalitis), UV radiation and air pollutants. Certified training options in professional journals and participation in lectures or workshops at relevant congresses were identified as the two preferred types of training. Especially professional journals as the most frequently used source of information could function as a suitable tool to reach as many paediatricians as possible. 76% of the paediatricians have not yet carried out any corresponding prevention activities, although information activities for parents or children were seen as being effective by 80%. Whereas the possibilities of integrating climate change-oriented prevention activities into everyday practice, were perceived less positively. The most frequent reason given was lack of time. DISCUSSION: To satisfy this future need for knowledge, but also for offerings from paediatricians for patients and their parents, concrete further continuous education and consultancy services must be prepared. In the future, further training offers, including the consultancy services, should be integrated into profession-specific training modules, presented at congresses, and then implemented into paediatricians' daily routine. CONCLUSION: The results of the study illustrate that the topic "climate change and health" has a high relevance for paediatricians and that information measures for parents are considered to be effective. Although paediatricians are concerned with the topic, there is an implementation deficit. Support is needed in the form of intensifying awareness-raising projects and educational modules for paediatricians to move from knowledge to action.

[Assessment of dentists' opinions on the cause of failure of adhesive composite restorations]. / Einschätzung von Zahnärzten zu vermuteten Gründen für das Scheitern von Kompositfüllungen mittels Adhäsivtechnik.

Aim of this study was to get an overview of what dentists estimate to be the reason for failure of adhesive composite restorations and to gain knowledge about potential future foci for targeted further education. Therefore, a survey about the fabrication of composite restorations was conducted in the course of seven dental conferences with the main topic tooth-prevention. A total of 577 dentists participated in the survey. The most often called estimated factor for failure of composite restorations was the "dentist" (70.7%), followed by "indication" (32.2%), "material" (8.5%) and "patient" (8.1%). Participants estimated insufficient drying and fluid management (67.9%), incorrect application of the adhesive system (41.8%), insufficient lightpolymerisation (31.2%) and errors in incremental technique (27.6%) to be the main mistakes. The participating dentists claimed to attach great importance to careful drying and fluid management (60.8%), thorough adhesive application (37.3%), adequate incremental technique (32.6%) and sufficient lightpolymerisation (28.8%) while placing their own restorations. According to the survey participants, the treating dentist has the greatest influence on the quality and longevity of composite restorations. Drying and fluid management was the most often called estimated reason for failure but at the same time the step which is given the greatest caution.

[The effect of tailored training courses in preanalytical procedures on the quality of laboratory results]. / Einfluss einer maßgeschneiderten Präanalytik-Fortbildung auf die Qualität der Laboruntersuchungen.

INTRODUCTION: In 31 to 75 percent of cases, errors in laboratory medicine have preanalytical causes such as erroneous blood sampling. Erroneous blood sampling may lead to false test results and additional laboratory cost; it may increase analyzing time and endanger the health of patients and employees. In particular, under- and overfilling of blood sampling tubes can considerably distort laboratory values. So far there has been a lack of studies investigating the effect of a tailored training for ward staff to improve preanalytical procedures on blood sampling. ISSUE: Can a tailored preanalytical training significantly reduce the number of commented under- and overfilled coagulation samples, reduce the number of hemolytic serum and lithium heparin samples and increase the number of standards-compliant blood sampling? METHODS: In an intervention study we compared the number of commented under- and overfilled coagulation tubes and the number of hemolytic serum and lithium heparin samples on the basis of laboratory data and, using participant observation, compared the blood sampling quality on a surgical ward before and after participation in a training course. Based on prior results of participant observation, a 20-minute training was conceptualized and conducted. Target criteria were a) the number of commented under- and overfilled coagulation tubes and b) the number of hemolytic serum and lithium heparin samples in a before/after comparison (Oct-Dec 2017 and Jan-Mar 2018 compared with Jun-Aug 2018) and an annual comparison (Jun-Aug 2017 compared to Jun-Aug 2018), and c) a standards-compliant performance of blood sampling in a before/after comparison (Apr 2018 and Jun 2018). The number of commented under- and overfilled coagulation tubes in the annual comparison was compared using the Chi-square test. RESULTS: After the training (Jun-Aug 2018) the number of commented under- and overfilled coagulation tubes decreased significantly in annual comparison to Jun-Aug 2017 (-68.07%, p < 0.001). The number of commented under- and overfilled coagulation tubes and of hemolytic serum and lithium heparin samples decreased in the before/after and in the annual comparison, and the number of standards-compliant blood samplings increased in the before/after comparison. CONCLUSION: The training contributed significantly to reducing the number of commented coagulation samples and hemolytic serum and lithium heparin samples and to increasing standards-compliant blood sampling. There is a need to investigate to what extent this concept can be transferred to other wards, and in which intervals further trainings should be conducted in order to maintain these positive effects.

[Assuring the quality of continuous professional development: An analysis of accreditation documents of the chambers of pharmacists in Germany]. / Qualitätssicherung in der pharmazeutischen Fortbildung: Eine Analyse der Akkreditierungsunterlagen der deutschen Apothekerkammern.

Accreditation of continuous professional training events is an important means to ensure quality. In Germany, the chambers of pharmacists accredit these events, i. e., they check the documents that the organizers of these events provide. The aim of this investigation was to compare the accreditation documents that the chambers of pharmacists publish on their websites. We developed explicit rating criteria concerning the categories quality of content, conflict of interest and sponsoring. The analysis revealed a huge discrepancy between the individual chambers of pharmacists and also in the way they addressed different items. The Federal Chamber of Pharmacists revised its accreditation requirements in early 2019, which raised the rating. However, there is still room for improvement. To ensure the quality of pharmaceutical continuous accreditation, the chambers of pharmacists should work towards establishing more stringent and uniform accreditation requirements.

[Leadership and management courses for clinicians]. / Ärztliche Führung im Krankenhaus. Praktischer Nutzen von ärztlichen Führungs- und Management Kursen aus subjektiver Sicht der Teilnehmenden.

OBJECTIVES: The aim of the present study was to evaluate the benefit of Leadership and Management Courses for clinicians, specifically which leadership and management contents are beneficial to their daily clinical work and whether these contents support their individual career. METHOD: E-mail invitations to participate in the study were sent to all 543 medical doctors of the University Hospital Hanover, Germany, who had taken part in one of the leadership and management courses offered between June 2005 and June 2015. The enquiry was carried out between June 1 and June 30, 2015. 84 e-mail addresses were no longer active; and so, N=459 clinicians actually received the invitation. Of these, 104 participated (22.7%). RESULTS: The study included 59 items. Six were free text items, twelve items were closed questions which could be answered by choosing from a drop down menu, and 41 were answered on a Likert scale from 0 (not fitting at all) to 10 (perfect fit). Based on the items answered on a Likert scale, the following scales and mean values were deduced: Job Satisfaction (M=7.44); Leadership (M=7.77); Trust (M=7.22); Striving for Power (M=7,45); negative Affect (M=4,91); Target Achievement Motivation (M=8.19); Communication (M=8.30) and Management (M=6.48). Regression analysis showed that Job- and Team Satisfaction can predict to what extent the participants regard themselves as good leaders. The study participants defined the following topics as very important: leadership and management style, managerial functions, team management, human resources development and project management. Further topics included rhetoric skills, presentation techniques, as well as basic economics such as understanding balance sheets, profit & loss statements and contribution margin calculation. 55% of the course contents were described as being directly applicable to their daily working environment. In the clinicians' view, the ideal leader acts as a role model (passing on values like respect, appreciation, honesty, openness, fairness, sense of justice, and empathy), someone who motivates his colleagues by giving them a vision, structure and transparency. The participants estimated that they met 60% of these qualifications. 51% of the participants found the course highly beneficial, and 45% rated it as being beneficial. 55% said that the course boosted their career. 96% were willing to attend further leadership and management courses. 98% would recommend the course to their colleagues. CONCLUSION: The return rate of 22.7%, the subjective benefit of the courses (96%), the willingness to attend such courses (96%) and to recommend them to colleagues (98%) demonstrates that clinicians are highly interested in leadership and management topics. This may be due to the fact that these topics are not part of the training program for medical students or junior doctors. Our findings are in consistent with organisational and psychological research results showing that "soft" psychological factors related to leadership topics are a significant and crucial factor behind the success of organisations and hospitals.

[Is the formal quality of multiple choice questions used for continuing medical education influenced by guidelines for authors provided by the publishing houses?] / Welchen Einfluss haben Autorenrichtlinien der Verlage auf die formale Qualität von CME-Fragen in der ärztlichen Fortbildung?

INTRODUCTION: The widespread use of flawed multiple choice questions (MCQs) in continuing medical education (CME) has been demonstrated in different studies. In recent years, quality control measures have been established by some German publishing houses to ensure the quality of MCQs. OBJECTIVES: The purpose of the present study is to evaluate whether the quality of author's guidelines and the quality of MCQs correlate and whether the quality of MCQs in CME has improved following the implementation of quality control measures. MATERIALS AND METHODS: A set of 720 items from 6 journals was selected for analysis. A list of 10 item-writing flaws provided by Kühne-Eversmann et al. was modified. The existing guidelines for authors of the six selected journals were categorized by their comprehensiveness. RESULTS: There were substantial differences in item quality with the percentage of flawed items ranging between 34 % and 92 % of all items published by a journal. One journal showed considerable improvement of item quality following the implementation of guidelines for authors (61 % flawed items in 2006 vs. 33% in 2012). The comprehensiveness of the author's guidelines correlated negatively with the number of item-writing flaws. CONCLUSIONS: The correlation between the existence of elaborate guidelines for authors and the absence of item-writing flaws in MCQs suggests that the publication of guidelines for authors could result in a higher quality of MCQs, even though the review process might have a major influence.

[Conflict of interest in continuing medical education - Studies on certified CME courses]. / Interessenkonflikte in der ärztlichen Fortbildung - Untersuchungen an zertifizierten Online-Fortbildungsangeboten.

OBJECTIVES: Although the problem of conflict of interest in medical education is discussed intensively, few valid data have been published on how to deal with the form, content, funding, sponsorship, and the influence of economic interests in continuing medical education (CME). Against this background, we carried out an analysis of data which had been documented for the purpose of certification by a German Medical Association. A central aim of the study was to obtain evidence of possible influences of economic interests on continuing medical education. Furthermore, strategies for quality assurance of CME contents and their implementation were to be examined. METHODS: We analyzed all registration data for courses certified in the category D ("structured interactive CME via print media, online media and audiovisual media") by the Bavarian Chamber of Physicians in 2012. To measure the effects of conflict of interest, relationships between topics of training and variables relating to the alleged self-interest of the organizer/sponsor (for example, drug sales in a group of physicians) were statistically verified. These data were taken from the Bavarian Medical Statistics 2012 and the GKV-Arzneimittelschnellinformation. RESULTS: In 2012, a total of 734 CME course offerings have been submitted for 51 medical specialties by 30 course suppliers in the Bavarian Medical Association. To ensure the neutrality of interests of the CME courses the course suppliers signed a cooperation treaty ensuring their compliance with defined behavior towards the Bavarian Medical Association concerning sponsorship. The correlation between course topics and drug data suggests that course suppliers tend to submit topics that are economically attractive to them. There was a significant correlation between the number of CME courses in a specific field and the sales from drug prescriptions issued by physicians in the respective field. CONCLUSIONS: The results show that neutrality of interests regarding continuing medical education is difficult to achieve under the current framework for the organization, certification, and especially the funding of CME events in Germany. The cooperation agreement between the Bavarian Medical Association and training applicants is taken as an example of how legal certainty can be ensured. Based on the findings described below, suggestions and strategies to strengthen assessment expertise of course participants have been developed and elaborated.

[Implementation of focused ultrasonography in an acute care setting]. / Implémentation de l'ultrasonographie ciblée dans une unité de soins critiques.

The legitimacy of intensivists and emergency physicians to use ultrasound in their daily practice is no longer questioned. This new tool is now considered essential in the acute care setting. After overcoming the technological and political obstacles, the current challenge is to implement technology in units. Here we give some recommendations based on our experience of the last fifteen years.

La légitimité des réanimateurs et des urgentistes à utiliser l'échographie dans leur pratique quotidienne n'est plus remise en question. Ce nouvel outil est actuellement considéré comme indispensable pour l'intensiviste et l'urgentiste. Après avoir surmonté les obstacles technologiques et politiques, le défi actuel est d'implémenter la technique dans les unités de soins. Nous donnons ici quelques recommandations basées sur notre expérience de ces dix dernières années.

[Practice report: Structured training to improve quality of care in emergency medical service. On-scene supervision: A new approach to emergency medical service training in Wiesbaden and Rheingau-Taunus-Kreis?]. / Bericht aus der Praxis: Strukturierte Fortbildung zur Verbesserung der Versorgungsqualität im Rettungsdienst. Einsatz-Supervision als neuer Ansatz im Bereich der Rettungsdienst-Fortbildung in Wiesbaden und im Rheingau-Taunus-Kreis?

In recent years, the emergency medical services in Wiesbaden and the Rheingau-Taunus district made great efforts to standardise structures. Since there are only few established procedures in the annual examinations for paramedics, there is reason to assume that treatment procedures for patients have not been standardised either. Materials and equipment are not handled uniformly, and employee satisfaction has significantly decreased over the last few years. To solve these problems, all paramedics undergo standardised and structured trainings. These training courses make use of the internationally accepted PHTLS (Pre-Hospital Trauma Life Support) and AMLS (Advanced Life Support Medial) programmes. In addition, practising skills and handling the equipment as well as on-scene supervision is to be established in practical training sessions.

[Continuing Medical Education in Germany - mandatory and voluntary obligations]. / Ärztliche Fortbildung in Deutschland -Pflicht und Freiwilligkeit.

After 1945 the common medical training infrastructure was broken up into two different political systems. While in the Federal Republic of Germany the structure was based on physicians' self-governance, in the German Democratic Republic medical professional structures were organised by the government. After the unification of the two German states, which took place on October 3, 1990, the centralistic structure was replaced by the system of physician self-governance. Before January 1, 2004, continuing medical education (CME) in West Germany relied on a system of voluntary obligations. In East Germany, though, professional CMEs were compulsory; they were called "obligatorische periphere Fortbildung." Based on 15 expert interviews on the topic of "CME in Germany", the different circumstances and conditions were analysed taking account of the historical background. Only selected professionals with experience in both German states (one with a federal, the other with a centralistic system), were chosen for the survey.