Supporting Older People to Live Safely at Home – Findings from Thirteen Case Studies on Integrated Care Across Europe

Introduction: While many different factors can undermine older people’s ability to live safely at home, safety as an explicit aspect of integrated care for older people living at home is an underexplored topic in research. In the context of a European project on integrated care, this study aims to improve our understanding of how safety is addressed in integrated care practices across Europe. Methods: This multiple case study included thirteen integrated care sites from seven European countries. The Framework Method guided content analyses of the case study reports. Activities were clustered into activities aimed at identifying and managing risks, or activities addressing specific risks related to older people’s functioning, behaviour, social environment, physical environment and health and social care receipt. Results: Case studies included a broad range of activities addressing older people’s safety. Although care providers felt they sufficiently addressed safety issues, older people were often concerned and insecure about their safety. Attention to the practical and social aspects of safety was often insufficient. Conclusions and discussion: Integrated care services across Europe address older people’s safety in many ways. Further integration of health and social care solutions is necessary to enhance older people’s perceptions of safety

Measuring older peoples’ experiences of person-centred coordinated care: experience and methodological reflections from applying a patient reported experience measure in SUSTAIN

Introduction While several evaluation studies on (cost-)effectiveness of integrated care have been conducted in recent years, more insight is deemed necessary into integrated care from the perspective of service users. In the context of a European project on integrated care for older people living at home (SUSTAIN), this paper shares the experience and methodological reflections from applying a Patient Reported Experience Measure (PREM) on person-centred coordinated care -the P3CEQ- among this population. Methods A combination of quantitative and qualitative data and analysis methods was used to assess the usability and the quality of applying a PREM among older people presenting complex care needs, using the P3CEQ delivery in SUSTAIN as a case study. 228 service users completed the P3CEQ and nine SUSTAIN researchers participated in a consultation about their experience administering the questionnaire. P3CEQ scores were analysed quantitatively using principal component analysis and multilevel linear regression. P3CEQ open responses and researcher notes collected when administering the questionnaire were thematically analysed. Results Service user inclusion was high and most P3CEQ items had low non-response rates. Quantitative analysis and researcher experience indicate the relevance of face-to-face administration for obtaining such an amount of data in this population group. The presence of a carer increased inclusion of more vulnerable respondents, such as the cognitively impaired, but posed a challenge in data interpretation. Although several P3CEQ items were generally understood as intended by questionnaire developers, the analysis of open responses highlights how questions can lead to diverging and sometimes narrow interpretations by respondents. Cognitive impairment and a higher educational attainment were associated with lower levels of perceived person-centredness of care. Conclusion This study shows essential preconditions to meaningfully collect and analyse PREM data on older peoples' experiences with integrated care: face-to-face administration away from care providers, collection of reasons for non-response and open comments providing nuances to answers, and multilevel modelling taking into account diversity in the target population. Several areas of improvement for future PREM use in this population have been identified: use of administration and coding guides, inclusion of clear and easy to understand definitions and examples illustrating what questions do and do not mean, measures of the expectations of person-centred coordinated care, and procedures ensuring sound ethical research. These methodological learnings can enhance future evaluation of integrated care from a service user perspective

Supplemental Material, ESD_PreventingCoups_Data - Preventing Coups d’état: How Counterbalancing Works

<p>Supplemental Material, ESD_PreventingCoups_Data for Preventing Coups d’état: How Counterbalancing Works by Erica De Bruin in Journal of Conflict Resolution</p

Supplemental Material, ESD_PreventingCoups_OnlineAppendix - Preventing Coups d’état: How Counterbalancing Works

<p>Supplemental Material, ESD_PreventingCoups_OnlineAppendix for Preventing Coups d’état: How Counterbalancing Works by Erica De Bruin in Journal of Conflict Resolution</p

Long-term micturition problems of asymptomatic postpartum urinary retention: a prospective case-control study

Covert (asymptomatic) postpartum urinary retention (PUR) is defined as post-void residual volume (PVRV) ≥150 mL. Although often supposed to be a common and harmless phenomenon, no data are available on the potential long-term micturition problems of increased PVRV after vaginal delivery. After the first spontaneous void post-vaginal delivery, PVRV was measured using a portable scanning device. Micturition symptoms were compared using validated questionnaires between women with PVRV < 150 mL and those with PVRV ≥150 mL until 1 year after delivery. Women with PVRV ≥ 150 mL were followed until complete bladder emptying was achieved. Data of 105 patients with PVRV < 150 mL and 119 with PVRV ≥ 150 mL were available for analysis. 75% of all patients included had PVRV ≥ 250 mL. More primiparous patients had PVRV ≥ 150 mL (p < 0.02). 92% of women with PVRV ≥ 150 mL after delivery were able to adequately empty their bladder within 4 days. One year after delivery, no statistically significant differences were found. Covert PUR according to the definition of PVRV ≥ 150 mL, is a common and transient phenomenon that does not result in more lower urinary tract symptoms 1 year after delivery. Although the current definition is not useful in identifying postpartum women with a pathological condition, we suggest that the definition of covert PUR should be change to: "PVRV≥500 mL after the first spontaneous void after (vaginal) delivery." This cut-off value is the value at which some women do need more time to normalise emptying of the bladder. The exact clinical implications of covert PUR need to be further studied in this subcategory of wome

Rh-Mediated Carbene Polymerization: from Multistep Catalyst Activation to Alcohol-Mediated Chain-Transfer

Rh-mediated polymerization of carbenes gives access to new highly substituted and stereoregular polymers. While this reaction is of interest for the synthesis of syndiotactic polymers that are functionalized at every carbon atom of the polymer backbone, the catalyst activation, chain-initiation, and chain-termination processes were so far poorly understood. In this publication we present new information about these processes on the basis of detailed end-group analyses, dilution-kinetic studies, and a comparison of the activity of well-defined catalysts containing a preformed Rh–C bond. All data point toward complex catalyst activation processes under the applied reaction conditions. The use of well-defined Rh^I(cod)-alkyl, aryl, and allyl complexes does <i>not</i> lead to better initiation efficiencies or higher polymer yields. MALDI-ToF MS of the oligomeric fractions indicates that during the incubation time of the reaction, the precatalysts are first transformed into oligomer forming species with a suppressed tendency toward β-hydrogen elimination, and accordingly a shift to saturated oligomeric chains that are terminated by protonolysis. Further catalyst modifications lead to a shift from atactic oligomerization to stereoregular high molecular weight polymerization activity. Dilution-kinetic studies reveal that under diluted conditions two different active species operate that differ largely in their chain-termination behavior. Analysis of the reaction products by MALDI-ToF MS also allows conclusions about chain-initiation and chain-termination. Chain-initiation can occur by insertion of a preformed carbene into a Rh-ligand or Rh-hydride bond or by (internal or external) nucleophilic attack of water and/or alcohol on a Rh-carbene moiety. Chain-termination takes place mainly by (nucleophilic) protonolysis involving water or alcohols, while β-H elimination plays only a minor role and is only observed for the shorter oligomers. The detection of ethoxy and hydroxyl end-groups demonstrates the importance of trace amounts of water and ethanol toward chain-initiation. Alcohols further function as a chain-transfer agent, and increasing the alcohol concentration accelerates the chain-transfer process (which remains however relatively slow compared to chain-propagation). On the basis of the chemical properties of the alcohols, we propose a chain-transfer mechanism involving nucleophilic attack of the alcohol (nucleophilic, σ-bond metathesis type, protonolysis). This further allows us to draw some (careful) new conclusions about the oxidation state of the actual polymerization species