Falk Hoffmann’s research while affiliated with Carl von Ossietzky Universität Oldenburg and other places

Introduction: We examined the practice and variability of indwelling urinary catheter changes in male nursing home residents. Methods: Cross-sectional data from a nationwide survey conducted in a representative sample of German nursing homes in 2023 were analyzed. The professions conducting most transurethral/suprapubic catheter changes in men were identified and proportions for whom respective catheters are changed in nursing homes were determined. Associations between these proportions and nursing home characteristics were investigated via multivariable logistic regressions. Results: Of 1,369 invited facilities, 330 (24.1%) participated. Urologists changed most catheters in 72.8% (transurethral catheters) and 88.3% (suprapubic catheters) of the facilities. The median proportion of men whose catheters were changed in nursing homes was 8.5% (transurethral catheters; interquartile range 0.6%–100.0%) and 1.0% (suprapubic catheters; IQR 0.0%–100.0%). Facilities in which urologists changed most catheters were less likely to have a high proportion (≥90%) of in-home catheter changes compared to the reference group (odds ratio 0.44 [transurethral catheters; 95% confidence interval 0.24–0.82] and 0.30 [suprapubic catheters; 0.12–0.76]). Conclusion: The proportion of men whose catheters were changed in nursing homes varied considerably between facilities and was lower where urologists were involved.

Background Non-life-threatening cases treated by emergency services have been increasing in recent years, especially in older people. In a region in Germany with approximately 600,000 inhabitants, the role of a specially trained community paramedic (Gemeindenotfallsanitäter, G-NFS) was introduced in 2019. The G-NFS is dispatched to low-acuity requests, attends the assignment alone and is allowed to treat patients at home. Aim The aim of this study was to analyse the assignments attended by the G-NFS relating to the suspected diagnoses, with a focus on older people (≥ 65 years) according to their care setting. Methods In this descriptive, retrospective study, we analysed the anonymous assignment report forms 07/2023–12/2023 of cases where patients were aged ≥ 65 years. The suspected diagnoses (free text field) were categorised according to the International Classification of Primary Care 2nd Edition (ICPC-2) scheme. Furthermore, baseline characteristics, urgency of the assignment, provided measures, transport and further treatment were analysed, stratified by care setting. Results Of the 1,643 included anonymous assignment report forms, 52.9% (n = 869) related to patients aged ≥ 65 years. In this population, the mean age was 80.7 years (SD 8.2), 49.6% were female and most were in long-term care, whether as home care recipients (34.8%) or as nursing home residents (26.9%). The most frequent diagnoses were categorised as urological (24.9%), general and unspecified (13.7%), circulatory (13.6%), digestive (12.8%), musculoskeletal (11.5%) and respiratory (10.3%). In 52.7% of the cases no transport was necessary, while 73.7% of urological cases did not need to be transported. Conclusion The G-NFS was dispatched mainly to older people. Most of them were in long-term care and were not transported. The most common suspected diagnoses were categorised as urological, followed by general and unspecified, and circulatory, and differed by care setting. There is a strong need to strengthen outpatient healthcare structures for low-acuity health issues in older and immobile patients.

Background Pain and depressive symptoms often co‐occur, but the influence of pain intensity remains unclear. This study analyses the association between pain intensity and depressive symptoms in the general adult German population. Methods Data was obtained from the cross‐sectional German Health Update Study (GEDA 2019/2020‐EHIS). Pain intensity in the last 4 weeks was categorized into no pain, mild, moderate, and severe. Depressive symptoms were assessed using the 8‐item Patient Health Questionnaire (PHQ‐8). The prevalence of depressive symptoms was analysed including a 95% confidence interval (95% CI). A multivariable logistic regression analysed associated factors with depressive symptoms by odds ratio (OR). Results Of 22,708 participants (51.0% women, 35.1% aged 45–64 years), 41.2% reported no pain, 32.1% mild, 15.3% moderate, and 11.5% severe pain. Depressive symptoms were present in 8.3% overall (women 9.1%, men 7.5%). Participants with no pain, mild, moderate, and severe pain reported depressive symptoms in 2.5%, 6.5%, 14.4%, and 27.1%, respectively. In the multivariable analysis, higher pain intensity was associated with a higher risk of depressive symptoms (mild pain OR 1.8, 95% CI 1.3–2.4; moderate pain OR 2.8, 95% CI 2.0–4.0; severe pain OR 4.0, 95% CI 2.8–5.6). Depressive symptoms were further associated with a Body Mass Index (BMI) under 18.5 kg m ⁻² (OR 2.4; 95% CI 1.4–4.1), but not with sex (OR 1.1; 95% CI 0.9–1.3). Conclusions Higher pain intensity increases the risk of depressive symptoms. We suggest regular assessment of pain and further assessment of depressive symptoms in patients with moderate or severe pain. Significance Statement Our study found a clear association between higher pain intensity and depressive symptoms in the general population across all types of pain. Further, being underweight was linked to depressive symptoms overall and the highest prevalence of depressive symptoms was found in underweight persons with severe pain. These findings highlight the importance of assessing depressive symptoms in patients with higher pain intensity, especially in underweight patients.

(1) Background: This study aims to examine rehabilitation service utilization among total knee arthroplasty (TKA) subjects and the influencing factors associated with rehabilitation-related satisfaction. (2) Methods: The FInGK study was a single-center prospective cohort study. Patients (≥18 years) undergoing primary or revision TKA in a German university hospital were consecutively recruited between December 2019–May 2021. The subjects filled in a questionnaire one day before surgery (t0) and at two (t1) and 12 (t2) months postoperatively. Multivariable logistic regression was conducted to determine the variables associated with the subjects’ rehabilitation-related satisfaction. (3) Results: A total of 236 out of 241 (97.9%) subjects participated in t1 (59.3% female; mean age: 68.2 years). Overall, 94.7% underwent post-TKA rehabilitation measures, with inpatient rehabilitation being the predominant choice (85.4%). In total, 77.6% of those with rehabilitation were satisfied or very satisfied with their rehabilitation in general. Multivariable logistic regression showed that female sex (OR 3.42; CI 1.73–6.75) and satisfaction with the surgery in general after two months (OR 4.50; CI 1.96–10.33) were associated with the subjects’ rehabilitation-related satisfaction. (4) Conclusions: We found a high utilization of rehabilitation services following TKA and a high rehabilitation-related satisfaction. In international comparison, the utilization of inpatient rehabilitation services was very high. Future research should investigate the effective components for rehabilitation-related satisfaction in both in- and outpatient TKA rehabilitation.

Das BMBF fördert mit dem Netzwerk Universitätsmedizin (NUM) und der Medizininformatik-Initiative (MII) zwei richtungsweisende strukturbildende Forschungsmaßnahmen, die nun zusammengeführt werden. Die Datenintegrationszentren (DIZ) der MII sollen im NUM verstetigt werden. Ziel ist der Aufbau einer einheitlichen Dateninfrastruktur, innerhalb der die vorhandenen Daten aus der klinischen Routineversorgung der 36 deutschen Universitätskliniken des NUM, aus klinischen Kohorten und klinisch-epidemiologischen Studien auf Antrag und über abgestimmte Prozesse für unterschiedliche Forschungsfragen genutzt werden können. Rechtsgrundlage bildet hierfür der mit Ethikkommissionen und Datenschutzbehörden abgestimmte und in allen NUM-Standorten implementierte „Broad Consent“ der Universitätsmedizin mit einem so genannten „Kassenmodul“, das die Erhebung und Verlinkung von medizinischen Routinedaten der gesetzlichen Krankenversicherung (GKV) und der privaten Krankenversicherungen (PKV) als eine Kategorie versorgungsnaher Daten (VeDa) erlaubt. Die Verknüpfung dieser Routinedaten mit Daten aus Klinikinformationssystemen bietet ein besonders hohes Potenzial, da keine Datenquelle allein ein vollständiges Bild der medizinischen Versorgung zeichnet und sich die beiden Datenquellen ideal komplementär ergänzen. Ziel ist es nun, in einer strategischen Partnerschaft mit gesetzlichen Krankenkassen und privaten Krankenversicherungen diese Routinedaten in die sichere, transparente und partizipative Forschungsinfrastruktur des NUM zu integrieren. Dies fördert den Forschungsstandort Deutschland und trägt entscheidend dazu bei, die Qualität und Sicherheit der Gesundheitsversorgung in Deutschland evidenzbasiert zu verbessern. With the Network of University Medicine (NUM) and the Medical Informatics Initiative (MII), the BMBF is funding two pioneering, structure-building research measures that are now being merged. The data integration centers (DIZ) of the MII are to be consolidated in the NUM. The aim is to establish a standardized research infrastructure within which the existing data from the clinical routine care of the 36 German university hospitals, from clinical cohorts and clinical-epidemiological studies can be used for various research questions upon request and via coordinated processes. The legal basis for this is the MII's "Informed Broad Consent", which has been agreed with ethics committees and data protection authorities and implemented in all NUM locations, with a so-called "health insurance module" that allows the collection and linking of routine medical data from statutory health insurance funds (GKV) and private health insurers (PKV) as a category of care-related data (VeDa). Linking this routine data with data from hospital information systems offers particularly high potential, as no single data source provides a complete picture of medical care and the two data sources complement each other optimally. The aim now is to integrate this routine data into the NUM's secure, transparent and participatory research infrastructure in a strategic partnership with statutory health insurance funds and private health insurance companies. This promotes Germany in its role as a research location and makes a decisive contribution to improving the quality and safety of healthcare in Germany in an evidence-based manner.

Purpose We aimed to synthesize the information needs of people with stroke (PwS) in recurrent stroke prevention. Methods In this scoping review we searched Medline (via PubMed), CINAHL, and PsycINFO from inception to June 5, 2023, to identify all studies describing the information needs of people 18 years and older who have suffered a stroke or transient ischemic attack within the past 5 years. We included qualitative and quantitative studies from developed countries published in German or English. Data analysis was performed following Arksey and O’Malley’s methodological framework for scoping reviews. Findings We screened 5822 records for eligibility and included 36 articles published between 1993 and 2023. None of the included studies used a comprehensive framework or defined information needs. Based on statements from PwS and their caregivers, PwS needed information on treatment, etiology, effects of stroke, prognosis, rehabilitation, discharge, life changes, care role, support options, information sources, and hospital procedures. The most frequently expressed needs were information on the treatment (77.8%) and stroke etiology (63.9%). The primary information source was healthcare professionals (85.7%), followed by written information (71.4%), family and friends (42.6%), and the internet (35.7%), with information provided directly by healthcare professionals being preferred. The timing of information transfer is often described as too early. Conclusion PwS are primarily interested in clinical information about stroke, for example, treatment and etiology, and less often in information about daily life, for example, rehabilitation, the role of care, or lifestyle changes. PwS prefer to receive information directly from healthcare professionals. Developing a shared understanding of PwS’s information needs is crucial to implement suitable strategies and programs for dealing with these needs in clinical practice.

Purpose Pain is a common symptom following proximal femoral fractures (PFF), however, information on its treatment in terms of agents and type of use (scheduled vs. pro re nata [PRN]) is scarce. The main objective of this study was to examine pain medication regimens according to pain intensity following PFF. Furthermore, we explored the utilization of medication plans. Methods The “ProFem”‐study on healthcare provision, functional ability, and quality of life after PFF is a German population‐based prospective cohort study based on statutory health insurance data and individually linked survey data from different time points including information on the currently used medication. This present analysis refers to the participants' baseline interviews (about 3 months following PFF) conducted from 2018 to 2019 in the participants' private surroundings. Results The study population comprised 444 participants (mean age: 81.2 years, 71.0% female). Half of them reported high intensity pain, and the mean value for the EuroQol visual analogue scale was 50.8. Most commonly used analgesics were metamizole and tilidine/naloxone. Among participants with high intensity pain, 21.9% received only PRN pain medication and 17.2% no pain medication at all. Overall, 61.5% of participants presented any (printed) medication plan and only 25.2% a “federal standardized medication plan” (BMP). Conclusion As a substantial number of patients reports high intensity pain about 3 months following a PFF, the large proportion of those receiving no or only PRN pain medication raises questions regarding the appropriateness of the therapy. The overall low utilization of the BMP indicates potential for improvement.