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Piccoli GB, Cupisti A, Aucella F, Regolisti G, Lomonte C, Ferraresi M, Claudia D, Ferraresi C, Russo R, La Milia V, Covella B, Rossi L, Chatrenet A, Cabiddu G, Brunori G. Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology. J Nephrol 2020; 33:681-698. [PMID: 32297293 PMCID: PMC7381479 DOI: 10.1007/s40620-020-00734-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/03/2020] [Indexed: 02/07/2023]
Abstract
High-technology medicine saves lives and produces waste; this is the case of dialysis. The increasing amounts of waste products can be biologically dangerous in different ways: some represent a direct infectious or toxic danger for other living creatures (potentially contaminated or hazardous waste), while others are harmful for the planet (plastic and non-recycled waste). With the aim of increasing awareness, proposing joint actions and coordinating industrial and social interactions, the Italian Society of Nephrology is presenting this position statement on ways in which the environmental impact of caring for patients with kidney diseases can be reduced. Due to the particular relevance in waste management of dialysis, which produces up to 2 kg of potentially contaminated waste per session and about the same weight of potentially recyclable materials, together with technological waste (dialysis machines), and involves high water and electricity consumption, the position statement mainly focuses on dialysis management, identifying ten first affordable actions: (1) reducing the burden of dialysis (whenever possible adopting an intent to delay strategy, with wide use of incremental schedules); (2) limiting drugs and favouring "natural" medicine focussing on lifestyle and diet; (3) encouraging the reuse of "household" hospital material; (4) recycling paper and glass; (5) recycling non-contaminated plastic; (6) reducing water consumption; (7) reducing energy consumption; (8) introducing environmental-impact criteria in checklists for evaluating dialysis machines and supplies; (9) encouraging well-planned triage of contaminated and non-contaminated materials; (10) demanding planet-friendly approaches in the building of new facilities.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Nephrology, Centre Hospitalier Le Mans, Le Mans, France.
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy.
| | - Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Filippo Aucella
- Nephrology and Dialysis Unit, IRCCS "Casa Sollievo Della Sofferenza" Scientific Institute for Research and Health Care, San Giovanni Rotondo, Italy
| | - Giuseppe Regolisti
- Department of Internal Medicine, Nephrology and Health Sciences, University of Parma, Parma, Italy
| | - Carlo Lomonte
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Martina Ferraresi
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - D'Alessandro Claudia
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Carlo Ferraresi
- Department of Mechanical and Aerospace, DIMEAS, Politecnico of Torino, Turin, Italy
| | - Roberto Russo
- Nephology Unit. Azienda Ospedaliera Universitaria Policlinico, Bari, Italy
| | | | - Bianca Covella
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Luigi Rossi
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
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Lüdecke D, Kofahl C. [Use of sedating medication and physical restraints for patients with dementia in acute care hospitals : A non-randomized case control study]. Z Gerontol Geriatr 2020; 53:138-144. [PMID: 32048012 PMCID: PMC8279997 DOI: 10.1007/s00391-020-01697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/20/2020] [Indexed: 11/09/2022]
Abstract
Hintergrund Auf Menschen mit Demenz mit stationär behandlungsbedürftiger Akuterkrankung ist der Großteil der Akutkrankenhäuser kaum vorbereitet. Dies birgt die Gefahr der Überforderung für das Personal. Demenzerkrankungen sind der häufigste Grund dafür, dass Krankenhauspersonal sedierende Medikamente verabreicht und bewegungseinschränkende Maßnahmen einsetzt. Zielsetzung Die vorliegende Studie untersucht Faktoren, die den (unangemessenen) Einsatz von sedierenden Medikamenten und bewegungseinschränkenden Maßnahmen beeinflussen. Methoden Eine nichtrandomisierte Fall-Kontroll-Studie wurde in 2 internistischen Abteilungen in Hamburg durchgeführt. In der Interventionsgruppe wurde ein spezielles Versorgungskonzept für Menschen mit Demenz implementiert. Die Versorgungsart in der Kontrollgruppe entsprach der Regelversorgung. Mit logistischen Regressionen wurden Zusammenhänge zwischen Faktoren wie Alter, Demenzschweregrad, Verhaltensauffälligkeiten, Barthel-Index oder Versorgungsart und dem Einsatz sedierender Medikamente bzw. bewegungseinschränkender Maßnahmen untersucht. Ergebnisse Herausfordernde Verhaltensweisen (OR = 1,32) und die Zugehörigkeit zur Kontrollgruppe (OR = 1,94) sind signifikant mit dem Einsatz sedierender Medikamente assoziiert. Ein geringerer Barthel-Index, längere Aufenthaltsdauer und die eine Behandlung in der Kontrollgruppe sind signifikant mit einer höheren Wahrscheinlichkeit des Einsatzes bewegungseinschränkender Maßnahmen assoziiert. Diskussion Der Einsatz sedierender Medikamente als auch bewegungseinschränkender Maßnahmen variiert stark zwischen Interventions- und Kontrollgruppe. Andere Studien, die zu ähnlichen Ergebnissen kommen, sehen verschiedene Bausteine spezieller Versorgungskonzepte als Gründe für diese Unterschiede. Dazu zählen neben der baulichen Gestaltung und räumlichen Aspekten auch demenzspezifische Schulungsangebote und ein angemessener Personalschlüssel. Dies vermag auch Unruhe und herausfordernde Verhaltensweisen aufseiten der Patienten zu reduzieren. Der Verzicht auf Sedierung und bewegungseinschränkende Maßnahmen hat nicht zuletzt auch positive Auswirkungen auf die Lebensqualität von Menschen mit Demenz.
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Affiliation(s)
- Daniel Lüdecke
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - Christopher Kofahl
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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Wunner C, Rupprecht R, Singler K, Söllner W, Waller C, Gosch M, Schubert A. Therapie mit Demenzkranken in einer geriatrischen Tagesklinik. Z Gerontol Geriatr 2020; 53:123-128. [DOI: 10.1007/s00391-019-01683-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
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Ramos JB, Duarte GS, Bouça-Machado R, Fabbri M, Mestre TA, Costa J, Ramos TB, Ferreira JJ. The Role of Architecture and Design in the Management of Parkinson's Disease: A Systematic Review. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1301-1314. [PMID: 32804100 PMCID: PMC7683074 DOI: 10.3233/jpd-202035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 12/04/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurological condition characterized by the development of daily disabling symptoms. Although the architecture and design of a PD patient's environment can hinder or facilitate full participation in daily activities, their putative role in the management of these patients has received little attention to date. OBJECTIVE We conducted a systematic review to evaluate the evidence of architectural and design features in the management of people with PD. METHODS An electronic database search of observational and experimental studies was conducted in MEDLINE and Embase from inception to May 2020, with two independent reviewers identifying the studies. Falls, fear of falling, postural instability, gait impairment/disability, and functional mobility were our outcomes of interest. RESULTS Thirty-six studies were included, among which nineteen were observational and seventeen were experimental studies (overall participants = 2,965). Pavement characteristics, notably unstable surfaces and level differences, were found to be a major cause of falling. Ground-based obstacles and confined/narrowed spaces were found to disturb gait, increase postural instability, and decrease functional mobility. Housing type did not appear to increase risk of falling, nor to significantly explain concerns about falling. CONCLUSION Findings suggest a need to adjust architectural features of the surrounding space to ensure appropriate care and provide a safe environment to PD patients. More evidence about the impact of such modifications on PD outcomes is needed.
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Affiliation(s)
- Joana Beisl Ramos
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Serviço de Anestesiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Gonçalo S. Duarte
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa.
Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Raquel Bouça-Machado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa.
Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
- CNS –Campus Neurológico Sénior, Torres Vedras, Portugal
| | - Margherita Fabbri
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa.
Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
- Department of Neuroscience Rita Levi Montalcini, University of Torino, Turin, Italy
| | - Tiago A. Mestre
- Department of Medicine, Parkinson’s Disease and Movement Disorders Center, Division of Neurology, The Ottawa Hospital Research Institute, University of Ottawa Brain and Mind Institute, Ottawa, Ontario, Canada
| | - João Costa
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa.
Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Tânia Beisl Ramos
- Centro de Investigação em Arquitetura, Urbanismo e Design (CIAUD), Faculdade de Arquitetura, Universidade de Lisboa, Lisbon, Portugal
| | - Joaquim J. Ferreira
- Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa.
Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
- CNS –Campus Neurológico Sénior, Torres Vedras, Portugal
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Hendlmeier I, Bickel H, Heßler-Kaufmann JB, Schäufele M. Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors. Z Gerontol Geriatr 2019; 52:212-221. [PMID: 31628613 PMCID: PMC6821661 DOI: 10.1007/s00391-019-01628-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.
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Affiliation(s)
- Ingrid Hendlmeier
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany.
| | - Horst Bickel
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Johannes Baltasar Heßler-Kaufmann
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Martina Schäufele
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany
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Lüdecke D, Poppele G, Klein J, Kofahl C. Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case-control study comparing a regular ward with a special care ward with dementia care concept. BMJ Open 2019; 9:e030743. [PMID: 31494617 PMCID: PMC6731932 DOI: 10.1136/bmjopen-2019-030743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients' QoL. DESIGN A non-randomised, case-control study including two internal medicine wards from hospitals in Hamburg, Germany. SETTING AND PARTICIPANTS In all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept. OUTCOME MEASURES Our main outcome was the QoL (range 0-100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL. RESULTS QoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: -4.9), psychotropic drug use (-4.4) and agitation (-2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7). CONCLUSIONS A special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.
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Affiliation(s)
- Daniel Lüdecke
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Poppele
- Station DAVID, Evangelisches Krankenhaus Alsterdorf, Hamburg, Germany
| | - Jens Klein
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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von Arnim CAF, Bartsch T, Jacobs AH, Holbrook J, Bergmann P, Zieschang T, Polidori MC, Dodel R. Diagnosis and treatment of cognitive impairment. Z Gerontol Geriatr 2019; 52:309-315. [PMID: 31161337 DOI: 10.1007/s00391-019-01560-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/07/2019] [Indexed: 01/14/2023]
Abstract
As a result of the aging population dementia is a growing challenge, especially in healthcare. Nevertheless, cognitive disorders are often not systematically evaluated, especially during hospital stays for other reasons; however, cognitive impairment is associated with a number of geriatric syndromes, including falls, delirium, dysphagia and lack of adherence to treatment plans. This article considers the current state of diagnosis and treatment of dementia. Non-pharmacological therapeutic approaches as well as current and future pharmacological treatment options are discussed. The drugs of choice for the symptomatic treatment of cognitive deficits in Alzheimer's disease and Parkinson-associated dementia are cholinesterase inhibitors and memantine; there is no specific pharmacological treatment for other types of dementia. Prevention and treatment of cardiovascular risk factors can potentially retard the progression of possibly all forms of dementia.
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Affiliation(s)
- Christine A F von Arnim
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | | | | | - Jill Holbrook
- Clinic for Neurogeriatrics and Neurological Rehabilitation, RKU, University and Rehabilitation Hospital Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | | | - Tania Zieschang
- University Clinic of Geriatric Medicine, Oldenburg University, Oldenburg, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Dpt. II Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Richard Dodel
- Geriatric Medicine, University Duisburg-Essen, Essen, Germany
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Huenefeld D, Rodde S, Bureick G, Elkeles B, Hasebrook J. Improving Treatment of Elderly Patients by Interprofessional Education in a Quality Network of Geriatric Medicine: Protocol for Evaluating an Educational Initiative. JMIR Res Protoc 2019; 8:e11067. [PMID: 31066716 PMCID: PMC6524453 DOI: 10.2196/11067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/28/2018] [Accepted: 03/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background All statistics on the development of demand for care for multimorbid elderly patients highlight the acute pressure to act to adequately respond to the expected increase in geriatric patient population in the next 15 years. Against this background, great importance must be attached to the improvement of cross-occupational group and cross-sector treatment of these patients. In addition, many professionals in the health care sector often have little knowledge about the special treatment and care needs of the elderly. Objective The Quality Network of Geriatric Medicine in north-west Germany is the body responsible for the project; with its member organizations, it provides care for over 400,000 inpatients and is thus one of the largest associations for geriatrics in Germany. The Quality Network conducts binding evaluated qualification measures for staff involved in the treatment and care of multimorbid elderly patients. The training offers are especially intended for staff who have not yet been trained in working with elderly patients. This approach is intended to improve the expertise of various occupational groups on different hierarchy levels, to include patients and their family members in the evaluation process, and to initiate changes within the organizations. Methods Various instruments are used in the evaluation of qualification measures: besides written surveys and questionnaires, structured work groups (consensus groups) and interviews are conducted. The evaluation starts before the qualification measures to determine the starting point and then continues during the measure and after its completion. This allows major findings to be integrated directly into the ongoing qualification program. At least 100 trainings on geriatric topics, 80 consensus groups, and 120 patients (and family members) are going to be included in the study. Results The evaluation of the educational initiative is funded by the State of Northrhine-Westfalia (Germany; LZG TG 71 001 / 2015 and LZG TG 71 002 / 2015). The results of the study will be published after review and approval by the state authorities – presumably by the end of 2019. The before and after comparison of the treatment-related outcomes at the beginning and near the completion of the educational initiative gives insights into how transfer-oriented education can improve the treatment of elderly patients across sector lines for inpatients as well as outpatients. The evaluation of the implementation of educational content in day-to-day work and occupational groups is to facilitate recommendations about economically sensible use of educational resources and about further adjustments to the training content. Conclusions The evaluation develops the foundation for targeted and needs-oriented qualification measures as well as transfer in cross-sector, multiprofessional networks. Instruments and results will be published and provided to other health care networks and institutions. The Quality Network will implement the results of the evaluation process in its member institutions. International Registered Report Identifier (IRRID) DERR1-10.2196/11067
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Affiliation(s)
- Daisy Huenefeld
- Board of the Foundation, St Franziskus Foundation, Muenster, Germany
| | - Sibyll Rodde
- zeb.healthcare, zeb.rolfes.schierenbeck.associates, Muenster, Germany
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Hendlmeier I, Bickel H, Hessler JB, Weber J, Junge MN, Leonhardt S, Schäufele M. [Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)]. Z Gerontol Geriatr 2017; 51:509-516. [PMID: 29110137 DOI: 10.1007/s00391-017-1339-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. METHODS From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. RESULTS A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. DISCUSSION The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.
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Affiliation(s)
- Ingrid Hendlmeier
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
| | - Horst Bickel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Johannes Baltasar Hessler
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Joshua Weber
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.,Hochschule für Soziale Arbeit Olten, Fachhochschule Nordschweiz, Olten, Schweiz
| | - Magdalena Nora Junge
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Klinikum rechts der Isar, München, Deutschland
| | - Sarah Leonhardt
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland
| | - Martina Schäufele
- Fakultät Sozialwesen, Hochschule Mannheim, Paul-Wittsack-Straße 10, 68163, Mannheim, Deutschland.
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