TY - JOUR A1 - Strobl, R. A1 - Müller, Martin A1 - Thorand, B. A1 - Linkohr, B. A1 - Autenrieth, C. S. A1 - Peters, A. A1 - Grill, E. ED - Elsevier, T1 - Men benefit more from midlife leisure-time physical activity than women regarding the development of late-life disability--results of the KORA-Age study JF - science direct N2 - Objective Encouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. Method This data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1–S4 surveys (1984–2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. Results We analysed 3333 persons with a mean follow-up of 18 ± 5.5 years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio) = 0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. Conclusion Elevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women KW - Aged KW - Aged 80 and over KW - physical activity KW - Disability evaluation Y1 - 2014 ER - TY - GEN A1 - Skudlik, Stefanie A1 - Lüftl, Katharina A1 - Zaglacher, Regina A1 - Zaglacher, Melina A1 - Müller, Martin T1 - Der Übergang von Zuhause ins Pflegeheim aus der Perspektive der Versorgungstriade. Interviewergebnisse als Grundlage für eine Interventionsentwicklung. Vortrag für den EbM-Kongress in Berlin am 14. März 2024 KW - Übergänge KW - Pflegebedürftigkeit Y1 - 2024 ER - TY - GEN A1 - Skudlik, Stefanie A1 - Hirt, Julian A1 - Döringer, Tobias A1 - Thalhammer, Regina A1 - Lüftl, Katharina A1 - Prodinger, Birgit A1 - Müller, Martin T1 - Herausforderungen und Versorgungsstrategien im Kontext von Pflegeheimeinzügen in Deutschland: Ein Scoping Review. Poster für den EbM-Kongress vom 22.-24. März 2023 in Potsdam KW - Pflegeheimeinzug Y1 - 2023 ER - TY - GEN A1 - Skudlik, Stefanie A1 - Hirt, Julian A1 - Döringer, Tobias A1 - Thalhammer, Regina A1 - Lüftl, Katharina A1 - Prodinger, Birgit A1 - Müller, Martin T1 - Challenges and care strategies during the transition to nursing home in Germany: A scoping review. European Nursing Kongress am 5. Oktober 2022, online KW - transition to nursing home Y1 - 2022 ER - TY - JOUR A1 - Skudlik, Stefanie A1 - Hirt, Julian A1 - Döringer, Tobias A1 - Thalhammer, Regina A1 - Lüftl, Katharina A1 - Prodinger, Birgit A1 - Müller, Martin T1 - Challenges and care strategies associated with the admission to nursing homes in Germany: a scoping review JF - BMC Nursing N2 - Background The admission to a nursing home is a critical life-event for affected persons as well as their families. Admission related processes are lacking adequate participation of older people and their families. To improve transitions to nursing homes, context- and country-specific knowledge about the current practice is needed. Hence, our aim was to summarize available evidence on challenges and care strategies associated with the admission to nursing homes in Germany. Methods We conducted a scoping review and searched eight major international and German-specific electronic databases for journal articles and grey literature published in German or English language since 1995. Further inclusion criteria were focus on challenges or care strategies in the context of nursing home admissions of older persons and comprehensive and replicable information on methods and results. Posters, only-abstract publications and articles dealing with mixed populations including younger adults were excluded. Challenges and care strategies were identified and analysed by structured content analysis using the TRANSCIT model. Results Twelve studies of 1,384 records were finally included. Among those, seven were qualitative studies, three quantitative observational studies and two mixed methods studies. As major challenges neglected participation of older people, psychosocial burden among family caregivers, inadequate professional cooperation and a lack of shared decision-making and evidence-based practice were identified. Identified care strategies included strengthening shared decision-making and evidence-based practice, improvement in professional cooperation, introduction of specialized transitional care staff and enabling participation for older people. Conclusion Although the process of nursing home admission is considered challenging and tends to neglect the needs of older people, little research is available for the German health care system. The perspective of the older people seems to be underrepresented, as most of the studies focused on caregivers and health professionals. Reported care strategies addressed important challenges, however, these were not developed and evaluated in a comprehensive and systematic way. Future research is needed to examine perspectives of all the involved groups to gain a comprehensive picture of the needs and challenges. Interventions based on existing care strategies should be systematically developed and evaluated to provide the basis of adequate support for older persons and their informal caregivers. KW - transition to nursing home Y1 - 2023 U6 - https://doi.org/10.1186/s12912-022-01139-y VL - 22 ER - TY - JOUR A1 - Silies, Katharina A1 - Schley, Angelika A1 - Sill, Janna A1 - Fleischer, Steffen A1 - Müller, Martin A1 - Balzer, Katrin T1 - Die COVID-19-Pandemie im akutstationären Setting aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege BT - Eine qualitative Studie JF - Pflege N2 - Hintergrund: Die COVID-19-Pandemie ist eine Ausnahmesituation ohne Präzedenz und erforderte zahlreiche Ad-hoc-Anpassungen in den Strukturen und Prozessen der akutstationären Versorgung. Ziel: Ziel war es zu untersuchen, wie aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege die stationäre Akutversorgung durch die Pandemiesituation beeinflusst wurde und welche Implikationen sich daraus für die Zukunft ergeben. Methoden: Qualitative Studie bestehend aus semistrukturierten Interviews mit fünf Verantwortlichen des leitenden Pflegemanagements und drei Hygienefachkräften in vier Krankenhäusern in Deutschland. Die Interviews wurden mittels qualitativer Inhaltsanalyse ausgewertet. Ergebnisse: Die Befragten beschrieben den auf die prioritäre Versorgung von COVID-19-Fällen hin umstrukturierten Klinikalltag. Herausforderungen waren Unsicherheit und Angst bei den Mitarbeiter_innen, relative Ressourcenknappheit von Material und Personal und die schnelle Umsetzung neuer Anforderungen an die Versorgungleistung. Dem wurde durch gezielte Kommunikation und Information, massive Anstrengungen zur Sicherung der Ressourcen und koordinierte Steuerung aller Prozesse durch bereichsübergreifende, interprofessionelle Task Forces begegnet. Schlussfolgerungen: Die in der COVID-19-Pandemie vorgenommenen Anpassungen zeigen Entwicklungspotenziale für die zukünftige Routineversorgung auf, z. B. könnten neue Arbeits- und Skill Mix-Modelle aufgegriffen werden. Für die Konkretisierung praktischer Implikationen sind vertiefende Analysen der Daten mit zeitlichem Abstand erforderlich. N2 - Background: The COVID-19-pandemic is an unprecedented, exceptional situation and necessitates numerous adaptations of structures and processes in the acute inpatient setting. Aim: The aim of this study was to explore how acute inpatient care was influenced by the pandemic and which implications may result for the future from nursing managers’ and hygiene specialists’ point of view. Methods: Qualitative study based on semi-structured interviews with five nursing managers and three hygiene specialists in four German acute care hospitals. Interviews were interpreted by using content analysis. Results: Interviewees described how everyday routines in their hospitals were adapted to the prioritized care for COVID-19 patients. Main challenges were uncertainty and anxiety among staff, relative scarcity of equipment and workforce resources and rapid implementation of new requirements for treatment capacities. This was addressed by targeted communication and information, large efforts to ensure resources and coordinated control of all processes by cross-department, interprofessional task forces. Conclusions: Adaptations made to the structures and procedures of care delivery during the pandemic hold potential for future improvements of routine care, e. g. new workplace and skill mix models. To identify detailed practical implications, a renewed and deepened data analysis is needed at a later point of time, with a larger distance to the period of the pandemic. KW - Krankenhäuser KW - Pflegemanagement KW - COVID-19-Pandemie KW - Rationierung KW - qualitative Studie Y1 - 2020 UR - https://doi.org/10.1024/1012-5302/a000756 VL - 33 IS - 5 SP - 289 EP - 298 ER - TY - JOUR A1 - Servaty, Ricarda A1 - Kersten, Annalena A1 - Brukamp, Kirsten A1 - Möhler, Ralph A1 - Müller, Martin T1 - Implementation of robotic devices in nursing care. Barriers and facilitators: an integrative review JF - BMJ Open N2 - Background: Robots in healthcare are gaining increasing attention; however, their implementation is challenging due to the complexity of both interventions themselves and the contexts in which they are implemented. The objective of this integrative review is to identify barriers to and facilitators of the implementation of robotic systems in nursing. Methods: Articles published from 2002 to 2019 reporting on projects to implement robotic devices in nursing care were searched on Medline (via PubMed), CINAHL and databases on funded research projects (Community Research and Development Information Services and Technische Informationsbibliothek) and in journals for robotic research in November 2017 and July 2019 for an update. No restrictions regarding study designs were imposed. All included articles underwent quality assessments with design-specific critical appraisal tools. Barriers to and facilitators of implementation were classified using the Context and Implementation of Complex Interventions framework. Results: After removing all duplicates, the search revealed 11 204 studies, of which 17 met the inclusion criteria and were included in the synthesis. The majority of the studies dealt with the implementation of robots designed to support individuals, either living at home or in nursing homes (n=11). The studies were conducted in Europe, the USA and New Zealand and were carried out in nursing homes, individual living environments, hospital units and laboratories. The quality of reporting and quality of evidence were low in most studies. The most frequently reported barriers were in socioeconomic and ethical domains and were within the implementation outcomes domain. The most frequently reported facilitators were related to the sociocultural context, implementation process and implementation strategies. Discussion: This review identified barriers to and facilitators of the implementation of robotic devices in nursing within different dimensions. The results serve as a basis for the development of suitable implementation strategies to reduce potential barriers and promote the integration of elements to facilitate implementation. PROSPERO registration number: CRD42018073486. KW - nursing KW - robotic device Y1 - 2020 UR - https://dx.doi.org/10.1136/bmjopen-2020-038650 VL - 10 IS - 9 SP - e038650 ER - TY - JOUR A1 - Seckler, Eva A1 - Regauer, Verena A1 - Rotter, Thomas A1 - Bauer, Petra A1 - Müller, Martin T1 - Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review JF - BMC Family Practice N2 - Background: Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods: A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies (main project reports) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results: Fourteen studies (seven main project reports and seven process evaluation reports) of the identified 8154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework. The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions: In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. KW - Systematic review KW - Critical pathways KW - Primary health care KW - General practitioners Y1 - 2020 UR - https://doi.org/10.1186/s12875-020-01179-w VL - 21 SP - 113 ER - TY - JOUR A1 - Seckler, Eva A1 - Regauer, Verena A1 - Krüger, Melanie A1 - Gabriel, Anna A1 - Hermsdörfer, Joachim A1 - Niemietz, Carolin A1 - Bauer, Petra A1 - Müller, Martin T1 - Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation JF - BMC Family Practice N2 - Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered). KW - Critical pathways KW - Primary health care KW - General practitioners KW - Aged KW - Vertigo KW - Dizziness KW - Physical therapy modalities KW - Implementation science KW - Feasibility studies Y1 - 2021 UR - https://doi.org/10.1186/s12875-021-01410-2 VL - 22 SP - 62 ER - TY - JOUR A1 - Schaeffler, F. A1 - Müller, Martin A1 - Huppert, D. A1 - Brandt, T. A1 - Tiffe, T. A1 - Grill, E. ED - Springer Link, T1 - Consequences of visual height intolerance for quality of life: a qualitative study. JF - Quality of life research N2 - Purpose Visual height intolerance (vHI) occurs when a trigger causes the apprehension of losing balance and falling. Depending on the severity of vHI, an avoidance behavior may develop in about 50 % of the thus afflicted, and it can have considerable impact on their daily life and interpersonal interactions. It seems obvious that such experiences may be impairing and distressing, but this has not yet been examined systematically. Objective of this study was to examine the consequences of vHI for quality of life. Methods A qualitative, phenomenological exploratory approach was chosen. Individual face-to-face interviews were conducted with individuals who had reported in a previous study that they were susceptible to vHI. The interview transcripts were segregated into distinct meaning units, which were used to create a coding guideline with meta- and subcodes. Meaning units were then systematically extracted and assigned to the appropriate codes. Weights and links were used to assign priorities for interpretation. Results Eighteen participants were interviewed (mean age 53, range 30–73; 11 females). Data analysis resulted in 29 meta-codes and 115 subcodes. Responses indicated that vHI can be very disabling and has a relevant impact on quality of life and daily activities of the affected persons, including their family life and behavior towards partner, children and friends. Conclusion Relevant topics for further quantitative studies were identified, for example, strategies of compensation and the influence of vHI on family life. Other quantitative studies should determine whether comorbidities and the typologies found in this study have consequences for individual therapeutic approaches. KW - Qualitative study KW - Quality of life KW - visual height intolerance KW - acrophobia KW - fear of heigts KW - anxiety Y1 - 2014 ER -