General practitioners' views and experiences in caring for patients after sepsis:a qualitative interview study

Contains fulltext : 232438.pdf (Publisher’s version ) (Open Access)BACKGROUND: Patients surviving critical illnesses, such as sepsis, often suffer from long-term complications. After discharge from hospital, most patients are treated in primary care. Little is known how general practitioners (GPs) perform critical illness aftercare and how it can be improved. Within a randomised controlled trial, an outreach training programme has been developed and applied. OBJECTIVES: The aim of this study is to describe GPs' views and experiences of caring for postsepsis patients and of participating a specific outreach training. DESIGN: Semistructured qualitative interviews. SETTING: 14 primary care practices in the metropolitan area of Berlin, Germany. PARTICIPANTS: 14 GPs who had participated in a structured sepsis aftercare programme in primary care. RESULTS: Themes identified in sepsis aftercare were: continuity of care and good relationship with patients, GP's experiences during their patient's critical illness and impact of persisting symptoms. An outreach education as part of the intervention was considered by the GPs to be acceptable, helpful to improve knowledge of the management of postintensive care complications and useful for sepsis aftercare in daily practice. CONCLUSIONS: GPs provide continuity of care to patients surviving sepsis. Better communication at the intensive care unit-GP interface and training in management of long-term complications of sepsis may be helpful to improve sepsis aftercare. TRIAL REGISTRATION NUMBER: ISRCTN61744782

Enabling Surgical Placement of Hydrogels through Achieving Paste-Like Rheological Behavior in Hydrogel Precursor Solutions

Hydrogels are a promising class of materials for tissue regeneration, but they lack the ability to be molded into a defect site by a surgeon because hydrogel precursors are liquid solutions that are prone to leaking during placement. Therefore, although the main focus of hydrogel technology and developments are on hydrogels in their crosslinked form, our primary focus is on improving the fluid behavior of hydrogel precursor solutions. In this work, we introduce a method to achieve paste-like hydrogel precursor solutions by combining hyaluronic acid nanoparticles with traditional crosslinked hyaluronic acid hydrogels. Prior to crosslinking, the samples underwent rheological testing to assess yield stress and recovery using linear hyaluronic acid as a control. The experimental groups containing nanoparticles were the only solutions that exhibited a yield stress, demonstrating that the nanoparticulate rather than the linear form of hyaluronic acid was necessary to achieve paste-like behavior. The gels were also photocrosslinked and further characterized as solids, where it was demonstrated that the inclusion of nanoparticles did not adversely affect the compressive modulus and that encapsulated bone marrow-derived mesenchymal stem cells remained viable. Overall, this nanoparticle-based approach provides a platform hydrogel system that exhibits a yield stress prior to crosslinking, and can then be crosslinked into a hydrogel that is capable of encapsulating cells that remain viable. This behavior may hold significant impact for hydrogel applications where a paste-like behavior is desired in the hydrogel precursor solution

Kiezmedizin erleben und gestalten - Entwicklung und Evaluation eines Wahlpflichtfaches mit dem Ansatz des forschenden Lernens

Objective: To develop and evaluate an elective for the 6th semester in the medical curriculum at Charité - Universitätsmedizin Berlin. In this elective, medical students could experience and test Community Oriented Primary Care, hence the integration of public health into primary care, by using explorative learning methods.Method: In three consecutive semester, all participants of the elective filled in a questionnaire before and after the elective. The self-developed questionnaire covered socio-demographic features, an evaluation of the elective as well as a self-assessment regarding learning objectives and attitudes. The results were analyzed descriptively; the learning success was measured by mixed model regression.Results: Thirty-one students (100% of the elective participants) took part in the evaluation, 30 of them (96.8%) at both survey dates. The students evaluated the elective and particularly the commitment of the teachers as very positive. The five-level Likert scale showed a significant growth of knowledge by an average of 1.3 points. The attitudes of the students hardly changed.Conclusion: Students can experience Public Health practically by means of Community Oriented Primary Care. In doing so, explorative learning is an appropriate method providing a significant increase in competences.Zielsetzung: Ziel war es, ein Wahlpflichtfach für das sechste Semester im Modellstudiengang Medizin an der Charité - Universitätsmedizin Berlin zu entwickeln und zu evaluieren. In diesem Wahlpflichtfach können Studierende mittels forschenden Lernens Community Oriented Primary Care, also die Integration von Public Health in die hausärztliche Versorgung, kennenlernen und erproben. Methodik: In drei konsekutiven Semestern (WS 2016/2017- SS 2018) wurden alle Teilnehmenden des Wahlpflichtfaches zu Beginn und nach Abschluss des Wahlpflichtfaches mittels eines selbstentwickelten Fragebogens befragt. Es wurden soziodemographische Merkmale, die Beurteilung des Wahlpflichtfaches sowie eine Selbsteinschätzung hinsichtlich der Lernziele und thematisch relevanter Einstellungen abgefragt. Die Analyse erfolgte deskriptiv und hinsichtlich des Lernerfolges als Mixed Modell Regression. Ergebnisse: Einunddreißig Studierende (100% der Teilnehmer am Wahlpflichtfach) nahmen an der Evaluation teil, davon 30 (96,8%) zu beiden Befragungszeitpunkten. Die Studierenden bewerteten das Wahlpflichtfach insgesamt und insbesondere das Engagement der Dozierenden sehr positiv. Hinsichtlich der Lernziele ergab sich ein deutlicher Wissenszuwachs von durchschnittlich 1,3 Punkten auf einer fünfstufigen Likertskala. Die Einstellungen der Studierenden änderten sich kaum. Schlussfolgerung: Public Health kann mittels Community Oriented Primary Care praktisch vermittelt werden. Die Methode des Forschenden Lernens ist gut geeignet und führt zu einem deutlichen Kompetenzgewinn