Organizational culture empowering nurses an residents in nursing homes.<strong></strong>

Purpose. If nurses should respect resident´s autonomy, nurses themselves must experience empowerment and respect for their own autonomy in the work environment. The purpose of this study is to get a deeper understanding of nurses’ perception of their own empowerment in the organization’s culture during an intervention program for strengthening autonomy. Design/methodology/approach. Guided semi-structured interviews and moderated group discussions were conducted before and after the intervention. A structured and evaluative content analysis of the text material were performed. Findings. In total 73 nurses and nurse aids working at frontline with the residents were voluntarily included into the study. New categories for nurses’ perceived empowerment and organizational culture could be derived from the text material. Originality/value. The study’s results deliver a theoretical model with a sophisticated system of categories for organizational culture as perceived by nurses that can be used for further qualitative and quantitative research and for a sustainable organization development.&nbsp

Comparing outcomes of ILD patients managed in specialised versus non-specialised centres.

BACKGROUND: Early appropriate diagnosis and treatment of interstitial lung diseases (ILD) is crucial to slow disease progression and improve survival. Yet it is unknown whether initial management in an expert centre is associated with improved outcomes. Therefore, we assessed mortality, hospitalisations and health care costs of ILD patients initially diagnosed and managed in specialised ILD centres versus non-specialised centres and explored differences in pharmaceutical treatment patterns. METHODS: An epidemiological claims data analysis was performed, including patients with different ILD subtypes in Germany between 2013 and 2018. Classification of specialised centres was based on the number of ILD patients managed and procedures performed, as defined by the European Network on Rare Lung Diseases. Inverse probability of treatment weighting was used to adjust for covariates. Mortality and hospitalisations were examined via weighted Cox models, cost differences by weighted gamma regression models and differences in treatment patterns with weighted logistic regressions. RESULTS: We compared 2022 patients managed in seven specialised ILD centres with 28,771 patients managed in 1156 non-specialised centres. Specialised ILD centre management was associated with lower mortality (HR: 0.87, 95% CI 0.78; 0.96), lower all-cause hospitalisation (HR: 0.93, 95% CI 0.87; 0.98) and higher respiratory-related costs (€669, 95% CI €219; €1156). Although risk of respiratory-related hospitalisations (HR: 1.00, 95% CI 0.92; 1.10) and overall costs (€-&nbsp;872, 95% CI €-&nbsp;75; €1817) did not differ significantly, differences in treatment patterns were observed. CONCLUSION: Initial management in specialised ILD centres is associated with improved mortality and lower all-cause hospitalisations, potentially due to more differentiated diagnostic approaches linked with more appropriate ILD subtype-adjusted therapy

Effects of influenza vaccination in patients with interstitial lung diseases: An epidemiological claims data analysis.

Rationale Vaccination is the most effective protection against influenza. Patients with interstitial lung diseases (ILD) represent a high-risk group for influenza complications. Thus, yearly influenza vaccination is recommended, but evidence on its effects is sparse. Objective This study aimed to compare all-cause mortality and all-cause and respiratory-related hospitalization between vaccinated and unvaccinated patients with ILD. Methods Using data from the largest German statutory health insurance fund (about 27 million insurees in 2020), we analyzed four influenza seasons from 2014/15 to 2017/18 and compared vaccinated to unvaccinated ILD patients. Starting from September 1 of each year we matched vaccinated to unvaccinated patients in a 1:1 ratio using a rolling cohort design. Mortality and hospitalization were compared with Kaplan-Meier plots and effects were calculated during the influenza season (in-season) with risk ratios (RR). Results Both, the vaccinated and the unvaccinated cohort included 7,503 patients in 2014/15, 10,318 in 2015/16, 12,723 in 2016/17, and 13,927 in 2017/18. Vaccination rates were low with 43.2% in season 2014/15 and decreased over time to 39.9% in season 2017/18. The RR for all-cause mortality were 0.79 (95%CI: 0.65, 0.97; p = 0.02) in season 2014/15, 0.66 (95%CI: 0.54, 0.80; p &lt; 0.001) in 2015/16, 0.89 (95%CI: 0.76, 1.04; p = 0.15) in 2016/17, and 0.95 (95%CI: 0.81, 1.12; p = 0.57) in 2017/18. The effects on all-cause hospitalization and respiratory-related hospitalization were similar in all seasons. Conclusions Although an unequivocally beneficial impact of influenza vaccination in patients with ILD could not be demonstrated, we observed promising results regarding avoidance of all-cause mortality in half of the seasons observed. Given the low vaccination rates, further efforts are necessary to improve rates in ILD patients

Pirfenidone vs. nintedanib in patients with idiopathic pulmonary fibrosis: A retrospective cohort study.

Background: Two antifibrotic drugs, pirfenidone and nintedanib, are licensed for the treatment of patients with idiopathic pulmonary fibrosis (IPF). However, there is neither evidence from prospective data nor a guideline recommendation, which drug should be preferred over the other. This study aimed to compare pirfenidone and nintedanib-treated patients regarding all-cause mortality, all-cause and respiratory-related hospitalizations, and overall as well as respiratory-related health care costs borne by the Statutory Health Insurance (SHI). Methods: A retrospective cohort study with SHI data was performed, including IPF patients treated either with pirfenidone or nintedanib. Stabilized inverse probability of treatment weighting (IPTW) based on propensity scores was applied to adjust for observed covariates. Weighted Cox models were estimated to analyze mortality and hospitalization. Weighted cost differences with bootstrapped 95% confidence intervals (CI) were applied for cost analysis. Results: We compared 840 patients treated with pirfenidone and 713 patients treated with nintedanib. Both groups were similar regarding two-year all-cause mortality (HR: 0.90 95% CI: 0.76; 1.07), one-year all cause (HR: 1.09, 95% CI: 0.95; 1.25) and respiratory-related hospitalization (HR: 0.89, 95% CI: 0.72; 1.08). No significant differences were observed regarding total (€−&nbsp;807, 95% CI: €−&nbsp;2977; €1220) and respiratory-related (€−&nbsp;1282, 95% CI: €−&nbsp;3423; €534) costs. Conclusion: Our analyses suggest that the patient-related outcomes mortality, hospitalization, and costs do not differ between the two currently available antifibrotic drugs pirfenidone and nintedanib. Hence, the decision on treatment with pirfenidone versus treatment with nintedanib ought to be made case-by-case taking clinical characteristics, comorbidities, comedications, individual risk of side effects, and patients’ preferences into account

Cost effects of a health coaching in children and adolescents with mental health and developmental disorders.

OBJECTIVE: Health coaching (HC) aims to strengthen the role of primary care pediatricians in the treatment of children and adolescents with mental health and developmental disorders by extending consultation time and using disease-specific manuals. We evaluated the effect of HC on costs of specialized, pediatrician, and overall care. METHODS: In a retrospective cohort study based on German health insurance claims data, we identified children aged up to 17 years with a newly diagnosed mental health and/or developmental disorder between 2013 and 2015. Patients getting HC were matched to patients receiving usual care. Costs were calculated for one year following the start of the treatment and compared by Two-Part and Gamma Models. Absolute costs and cost differences were calculated with bootstrapped 95% confidence intervals. RESULTS: We compared 5,597 patients receiving HC with 5,597 control patients. The probability of incurring specialized care costs was similar between the groups (0.96, CI95%: 0.88; 1.05). However, for those who did incur costs, specialized care costs were significantly lower for HC-treated patients (0.77, CI95%: 0.63; 0.93). Accordingly, specialized care costs were lower by €-94 (CI95%: €-175; €-18), while pediatrician care costs were higher for HC-treated patients by €57 (CI95%: €49; €64). Hence, overall costs did not differ between the groups (€-59, CI95%: €-191; €71). CONCLUSION: Provision of HC has the potential to lower the costs of specialized care, while increasing the costs of pediatrician care. Overall costs did not differ, suggesting that the additional costs incurred by the HC were offset

Thromboxane A2 receptor and MaxiK-channel intimate interaction supports channel trans-inhibition independent of G-protein activation

Large conductance voltage- and calcium-activated potassium channels (MaxiK, BKCa) are well known for sustaining cerebral and coronary arterial tone and for their linkage to vasodilator β-adrenergic receptors. However, how MaxiK channels are linked to counterbalancing vasoconstrictor receptors is unknown. Here, we show that vasopressive thromboxane A2 receptors (TP) can intimately couple with and inhibit MaxiK channels. Activation of the receptor with its agonist trans-inhibits MaxiK independently of G-protein activation. This unconventional mechanism is supported by independent lines of evidence: (i) inhibition of MaxiK current by thromboxane A2 mimetic, U46619, occurs even when G-protein activity is suppressed; (ii) MaxiK and TP physically associate and display a high degree of proximity; and (iii) Förster resonance energy transfer occurs between fluorescently labeled MaxiK and TP, supporting a direct interaction. The molecular mechanism of MaxiK–TP intimate interaction involves the receptor's first intracellular loop and C terminus, and it entails the voltage-sensing conduction cassette of MaxiK channel. Further, physiological evidence of MaxiK–TP physical interaction is given in human coronaries and rat aorta, and by confirming TP role (with antagonist SQ29,548) in the U46619-induced MaxiK inhibition in human coronaries. We propose that vasoconstrictor TP receptor and MaxiK-channel direct interaction facilitates G-protein–independent TP to MaxiK trans-inhibition, which would promote vasoconstriction