Paenibacillus larvae Bacteremia in Injection Drug Users

Paenibacillus larvae causes American foulbrood in honey bees. We describe P. larvae bacteremia in 5 injection drug users who had self-injected honey-prepared methadone proven to contain P. larvae spores. That such preparations may be contaminated with spores of this organism is not well known among pharmacists, physicians, and addicts

Effects of the interdisciplinary basel delirium and dementia prevention and management program demdel

Background: In hospital, delirium is a relatively common complication of acute illness and medical procedures among high risk patients groups such as older patients and patients with dementia. The experience of delirium is frightening and likened to a nightmare, in addition to the acute and distressing state the long-term consequences are detrimental. It is estimated that one third of deliria are preventable, to minimise negative consequences the remaining two thirds have to be managed. However, delirium management is variable and often overlooked. The evidence of the benefits of early intervention and treatment for patients with dementia is unclear although generally presumed to be beneficial. The aim of this study was to investigate the effect a systematic dementia-delirium management program DEMDEL on patient outcomes and to explore implementation challenges and patient acceptability. Methods: Central to this investigation was a mixed method intervention study. The main study focussed on quantitative outcome measures. An additional small qualitative investigation of practice delivery issues and user experiences was achieved through in-depth interviews with patients and focus group interviews with nurses. Setting: The study was conducted on four wards of the Medical Department of the University Hospital Basel in Switzerland. Sample: 268 patients aged 70 years and above with cognitive impairment participated in the before-after comparison study, 8 patients in the qualitative interviews and IQ nurses in two focus groups. Measurements: Daily delirium was measured using the Confusion Assessment Method (Cam) and the Delirium Rating Scale Revised 98 (DRS-R-98). Interventions: Nurses and physicians received training sessions on the state of the art concerning the prevention, early recognition and treatment of deliria. An algorithm (DemDel) on prevention of delirium, systematic screening for cognitive impairment and delirium by nurses and 00 the handling of delirious patients was introduced: Nurses identified high risk patients; i.e. patient with cognitive impairment using the clock drawing test, influenced the doctor's prescription of sleeping and delirium rescue medications, conducted systematic delirium screening with the Delirium Observation Scale and immediately administered the prescribed rescue medication after the onset of delirium.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Zugang mobiler Gesundheitstechnologien zur GKV

Gensorowsky D, Düvel J, Hasemann L, Greiner W. Zugang mobiler Gesundheitstechnologien zur GKV. Gesundheitsökonomie & Qualitätsmanagement. 2019.**Hintergrund** An den Einsatz gesundheitsbezogener digitaler Anwendungen auf mobilen Endgeräten („Gesundheits-Apps“) sind große Nutzenerwartungen geknüpft. Die regelhafte Bereitstellung dieser mobilen Gesundheitstechnologien über die Gesetzliche Krankenversicherung (GKV) erfolgt bislang jedoch nicht. Dies lässt die Existenz struktureller Probleme im Zugang zur GKV-Erstattung vermuten. **Ziel** Ziel dieser Studie ist die Identifikation von Herausforderungen, welche den erfolgreichen GKV-Zugang mobiler Gesundheitstechnologien erschweren. **Material und Methoden** Zwischen acht und zwölf Vertreter zentraler am Zugangsprozess beteiligter Akteursgruppen diskutierten in fünf teilstrukturierten Fokusgruppeninterviews die Herausforderungen entlang potenzieller GKV-Zugangswege. Die Auswertung erfolgte mittels zusammenfassender Inhaltsanalyse nach Mayring. **Ergebnisse** Es wurden zugangswegübergreifende und -spezifische Herausforderungen identifiziert. Übergreifend nahmen die Interviewten Wissens- und Informationsdefizite bezüglich der Zugangsanforderungen sowie die fehlende Vereinbarkeit mobiler Gesundheitstechnologien mit den segmentierten Regelungsbereichen des SGB V als Problemfelder wahr. Die Bereiche Primärprävention und Selektivverträge wurden als bereits gut geebnete Wege in die Erstattung erachtet. Für die Bereiche Neue Untersuchungs- und Behandlungsmethoden, Heil- und Hilfsmittelversorgung wurden größere Herausforderungen identifiziert, die neben unklarer Zugangseignung verschiedene prozessuale Hürden umfassen. **Schlussfolgerung** Die bessere Nutzung der Potenziale mobiler Gesundheitstechnologien erfordert die Adressierung der beschriebenen Herausforderungen durch gesetzliche und untergesetzliche Maßnahmen. Angesichts der heterogenen Positionen sollte die Entwicklung dieser Lösungsansätze unter enger Einbindung der Stakeholder erfolgen

An advanced practice nurse-led delirium consultation service reduces delirium severity and length of stay in orthopedic patients: A nonrandomized posttest only evaluation study

Delirium is an acute neuropsychiatric disorder and is a common and serious complication during hospitalization for older people. This study evaluated the value of an advanced practice nurse (APN)-led delirium consultation service on patient outcomes DESIGN AND METHODS: This was a retrospective chart review of 137 patients over 65 years, hospitalized between 2012 and 2015 in a tertiary care setting in Switzerland, who underwent orthopedic surgery and experienced delirium.; Of the 137 eligible patients, 53 received the delirium consultation service and 84 received the standard care. The group receiving "early" delirium consultation experienced significantly reduced delirium severity over the course of time and the shortest length of stay.; The APN-led delirium consultation service had a positive effect on patient outcomes

Digital Health Applications: A Qualitative Study of Approaches to Improve Access to Statutory Health Insurance

Düvel J, Gensorowsky D, Hasemann L, Greiner W. Lösungsansätze für den Zugang digitaler Gesundheitsanwendungen zur Gesetzlichen Krankenversicherung: eine qualitative Studie. Gesundheitswesen. 2021;83:1-11.BACKGROUND: There is a lack of integration of appropriate digital health applications (DiGA) into the first healthcare market in Germany. In order to enable a valid and reliable use of previously examined digital health products, their implementation into services of the statutory health insurance (SHI) is necessary. The aim of this study was the development of strategies to modify and improve access of DiGA to SHI reimbursement. The recently introduced Digitale-Versorgung-Gesetz (DVG) is an initial step in this direction.; METHODS: Using a qualitative approach, focus group interviews were conducted with key stakeholders of existing access paths. Previously elaborated problem-solving approaches were discussed. The approaches ranged between adapting existing structures and implementing an original digital pathway. Subsequently, a comparison of the project results and legislative provision of the DVG was carried out.; RESULTS: The proposed approaches were discussed heterogeneously and varied depending on the position of the participants. The implementation of an Advisory Council had a greater consensus than the introduction of a digital-specific pathway. Also individual measures like administrative support for generating the necessary evidence was considered as positive and beneficial. However, a deviation from the current evidence standards should be avoided. Furthermore, the legitimacy and time expenditure for the digital-specific pathway was called into doubt.; CONCLUSIONS: In principle, a better focus on existing structures on digital health applications can be endorsed. For a short-term use of DiGA potentials, adaptions of existing structures are preferable. The DVG legislation, although conforming to the project results only to some degree, can be considered as a first step. An amendment, in particular from the viewpoint of diagnostic or therapeutic DiGA, appears to be necessary. Georg Thieme Verlag KG RudigerstraSSe 14, 70469 Stuttgart, Germany

Impact, scope of practice and competencies of Advanced Practice Nurses within APN-led models of care for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings: a scoping review protocol

Introduction The increase of young and middle-aged adult patients with multimorbid and/or complex chronic conditions has created new challenges for healthcare systems and services. Advanced Practice Nurses (APNs) play an essential role in treating these patients because of their expertise and advanced nursing skills. Little is known about competencies, scope of practice and impact of APNs within APN-led care models for young and middle-aged adult patients with multimorbidity and/or complex chronic conditions in hospital settings. The objective of this scoping review is to describe the impact, scope of practice and competencies of APNs within APN-led care models for young and middle-aged adult patients in hospital settings.Methods and analysis This scoping review will be conducted using the methodological framework proffered by Arksey and O'Malley, incorporating the methodological enhancement of Levac et al. It will comply with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for Scoping Reviews’ guidelines of Tricco et al. Systematic research will be conducted in the databases MEDLINE (PubMed), CINAHL (EBSCO), EMBASE (Ovid), CENTRAL and PsycINFO (Ovid) using all recognised keywords, index terms and search strings. Grey literature will be scanned. Bibliography of all selected studies will be hand searched. Studies will be selected based on defined inclusion and exclusion criteria, screened by title and abstracts. Data from full-text articles meeting the inclusion criteria will be extracted independently by two authors. Disagreements in evaluation will be discussed and resolved by consensus. Results will be reported in the form of descriptive tables. Narrative summery is used to present the results of the review in the context of the study’s objectives and questions.Ethics and dissemination This scoping review does not require ethics approval. The review will be handed in as part of a doctoral thesis and published in a peer-reviewed journal.Trial registration number OSF 4PM38

Experience of adult patients and professionals with a program for the prevention of alcohol withdrawal delirium in the acute care setting - A case study

To investigate the experiences of adult patients and professionals with the prevention of alcohol withdrawal delirium program DESIGN AND METHODS: A simple, descriptive case study with several units of analysis was chosen as the study design.; Six patients, 15 nurses, one family member, and two physicians METHODS: Semi-structured interviews and observation sessions. The Braun and Clarke thematic analysis method was used for the data analysis.; Three main themes were identified: "Talking about alcohol," "Monitoring withdrawal symptoms," and "Collaboration with the Advanced Practice Nurse for delirium management."; The program is highly beneficial in this field of practice and is widely accepted by all those involved. The Advanced Practice Nurse played an important role to facilitate the processes