Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]

<p>Abstract</p> <p>Background</p> <p>Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.</p> <p>Methods</p> <p>The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session.</p> <p>The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160).</p> <p>Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.</p> <p>Discussion</p> <p>To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.</p

Interprofessional nutrition management – implementation and evaluation of a course for medical and nursing students using research-based learning method

Objective: The aim of the teaching project "Interprofessional Nutrition Management in Inpatient and Home Care" of the Medical Faculty of the Heinrich Heine University (HHU) and the Fliedner University of Applied Sciences Düsseldorf (FFH) was to test an interprofessional training session on the topic of malnutrition using the method of research-based learning to evaluate feasibility.Method: In the teaching project for medical and nursing students, research-based learning was applied in a case-based cross-sector setting. The teaching project was assessed quantitatively by the participating students through questionnaires and four newly-developed scales. The modeling and reliability of the scales (from 1 to 5) was confirmed by an exploratory factor analysis and Cronbach's alpha. The scales were evaluated descriptively and through inferential statistics.Results: The medical (n=21) and nursing students (n=25) rated the teaching project positively. Across all professional groups, the social context between the students (M=4.6) and the relevance of the topic (M=4.47) were rated very highly. The use of research-based learning (M=3.9) and the final assessment of the training session (M=3.9) were rated as satisfactory.Conclusions: The method of research-based learning proved to be very suitable for interprofessional education, as it enabled situations which encouraged the health professionals to learn from one another, about one another and with one another. Through the interdisciplinary discussion of malnutrition, cooperation skills and initial competences in nutritional management can be cultivated in future doctors and nursing staff even during training.Zielsetzung: Ziel des Lehrprojektes "Interprofessionelles Ernährungsmanagement in der stationären und häuslichen Versorgung" der Medizinischen Fakultät der Heinrich-Heine-Universität (HHU) und der Fliedner Fachhochschule Düsseldorf (FFH) war es eine interprofessionelle Lehrveranstaltung zum Schnittstellenthema Mangelernährung mit der Methode des Forschenden Lernens zu erproben und deren Machbarkeit zu evaluieren.Methodik: In dem Lehrprojekt für Medizin- und Pflegestudierende wurde Forschendes Lernen in einem fallbasierten sektorenübergreifenden Setting angewendet. Das Lehrprojekt wurde quantitativ mittels Fragebogen und vier neuentwickelten Skalen von den teilnehmenden Studierenden bewertet. Die Modellbildung und die Reliabilität der Skalen (Breite 1-5) wurde durch eine explorative Faktorenanalyse und Cronbachs Alpha abgesichert. Die Skalen wurden deskriptiv sowie inferenzstatistisch ausgewertet.Ergebnisse: Die Medizin- (n=21) und Pflegestudierenden (n=25) evaluierten das Lehrprojekt positiv. Berufsgruppenübergreifend wurde das Sozialklima zwischen den Studierenden (M=4,6) und die Relevanz des Themas (M=4,47) sehr hoch eingeschätzt. Die Anwendung des Forschenden Lernens (M=3,9) und die abschließende Einschätzung der Lehrveranstaltung (M=3,9) wurden als zufriedenstellend bewertet.Schlussfolgerungen: Die Methode des Forschenden Lernens erwies sich für interprofessionelle Ausbildung als sehr geeignet, da sie Lernsituationen ermöglichte, in welchen das von-, über- und miteinander Lernen der Gesundheitsberufe gefördert wurde. Durch die professionsübergreifende Auseinandersetzung mit Mangelernährung können bereits in der Ausbildung Kooperationskompetenzen und erste Handlungskompetenzen für Ernährungsmanagement bei den zukünftigen Ärztinnen und Ärzten und Pflegenden angebahnt werden

Are administrative data valid when measuring patient safety in hospitals? A comparison of data collection methods using a chart review and administrative data

Objective: To evaluate the validity and reliability of German Diagnosis Related Group administrative data to measure indicators of patient safety in comparison to clinical records. Design: A cross-sectional study was conducted using chart review (CR) as gold standard and screening of associated administrative data based on DRG coding. Setting: Three German somatic acute care hospitals for adults. Participants: A total of 3000 cases treated between May and December, 2010. Main outcome measures: Eight indicators were used to analyse the incidence of associated adverse events (AEs): pressure ulcers, catheter-related infections, respiratory failure, deep vein thromboses, hospital-acquired pneumonia, acute renal failure, acute myocardial infarction and wound infections. We calculated sensitivity, specificity, positive predictive value (PPV) and Cohen's Kappa with 95% confidence intervals. Results: Screening of administrative data identified 171 AEs and 456 were identified by CR. A number of 135 identical events were identified by both methods. Sensitivities for the detection of AEs using administrative data ranged from 6 to 100%. Specificities ranged from 99 to 100%. PPV were 33 to 100% and reliabilities were 12 to 85%. Conclusions: Indicators based on German administrative data deviate widely from indicators based on clinical data. Therefore, hospitals should be cautious to use indicators based on administrative data for quality assurance. However, some might be useful for case findings and quality improvement. The precision of the evaluated indicators needs further development to detect AEs by the valid use of administrative data

Immunomodulatory Properties of BRAF and MEK Inhibitors Used for Melanoma Therapy—Paradoxical ERK Activation and Beyond

The advent of mitogen-activated protein kinase (MAPK) inhibitors that directly inhibit tumor growth and of immune checkpoint inhibitors (ICI) that boost effector T cell responses have strongly improved the treatment of metastatic melanoma. In about half of all melanoma patients, tumor growth is driven by gain-of-function mutations of BRAF (v-rat fibrosarcoma (Raf) murine sarcoma viral oncogene homolog B), which results in constitutive ERK activation. Patients with a BRAF mutation are regularly treated with a combination of BRAF and MEK (MAPK/ERK kinase) inhibitors. Next to the antiproliferative effects of BRAF/MEKi, accumulating preclinical evidence suggests that BRAF/MEKi exert immunomodulatory functions such as paradoxical ERK activation as well as additional effects in non-tumor cells. In this review, we present the current knowledge on the immunomodulatory functions of BRAF/MEKi as well as the non-intended effects of ICI and discuss the potential synergistic effects of ICI and MAPK inhibitors in melanoma treatment

Preference towards HIV Self-Testing above Other Testing Options in a Sample of Men Who Have Sex with Men from Five European Countries.

We analyzed men who have sex with men (MSM) from Denmark, Germany, Greece, Portugal and Spain to identify who would choose HIV self-testing as their preferred testing method and assessed their preferred setting to acquire a self-testing kit and to confirm a reactive result. In 2016, we recruited an online sample of 3725 HIV-negative MSM. We used Poisson regression to identify factors associated with choosing self-testing as the preferred testing option. For those choosing it as their preferred option, we assessed the preferred settings to acquire a self-testing kit and to confirm a reactive result. Not being open about one's sexual behaviors with men was associated with choosing self-testing as the preferred option, except in Greece; older age in Greece and Spain; reporting condomless anal intercourses (CAI) in Germany and Portugal; reporting one previous test in Greece; between 2 and 5 in Spain and with having been tested ≥ 12 months ago in Germany, Portugal and Spain. The internet (32.8%) was the preferred place to acquire a self-testing kit and primary care (34.0%) for confirmation purposes. Self-testing was highly valued, especially among individuals who were not open about their sexual behaviors with men. In certain countries, it was also associated with older age, CAI and being undertested.This study was supported by Consumers, Health and Food Executive Agency (CHAFEA: 20131101) and Acción Estratégica Intramural (PI17CIII/00037). The funding sources were not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report, or in the decision to submit the paper for publication.S

Recommendations for a Core Curriculum for Master's Degree Programs in Health Services Research

The aim of the present study was to develop recommendations for a core curriculum for master's degree programs in health services research. For this purpose, a standardized online survey of university lecturers was conducted in the first step. In the second step, the curricula of the existing study programs were analyzed. In the third step, a literature search was conducted. In the last step, the resulting recommendations were discussed in a panel of experts. The final recommendations comprise 13 topics on five guiding questions with 26 subtopics. The main topics come from the areas of basic sciences in the context of health services research, the health care system and health policy, the (empirical) health services research process, and knowledge transfer. The present recommendations will serve as a basis for discussion and as a starting point. The development of recommendations should be seen as an ongoing process, as the core competencies of health services researchers will have to be continuously adapted to new research topics, new research methods and regulations

Memorandum III, Part 3: Quality of Care and Patient Safety Research Methods

The German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e.V. (DNVF)] fosters the methodological quality of health services research studies by memoranda and other initiatives. Quality of care and patient safety research (QCPSR) form core areas of health services research. The present memorandum explicates principal QCPSR questions and methods. Based on the issues' particular relevance for health policy, the memorandum exemplifies methods for developing and testing indicators, risk adjustment techniques, methods for collecting patient safety data, tools to analyse patient safety incidents and methods for evaluating often complex and multicomponent QCPS interventions. Furthermore, we point out urgent research topics

Potential of HIV Self-Sampling to Increase Testing Frequency Among Gay, Bisexual, and Other Men Who Have Sex With Men, and the Role of Online Result Communication: Online Cross-Sectional Study.

Late HIV diagnosis remains frequent among the gay, bisexual, and other men who have sex with men (GBMSM) population across Europe. HIV self-sampling could help remove barriers and facilitate access to testing for this high-risk population. We assessed the capacity of HIV self-sampling to increase the testing frequency among GBMSM living in Denmark, Germany, Greece, Portugal, Romania, and Spain, and evaluated the role of new technologies in the result communication phase. We analyzed a convenience sample of 5019 GBMSM with prior HIV testing experience who were recruited during 2016 through gay dating websites. We estimated the proportion of GBMSM who reported that the availability of self-sampling would result in an increase of their current testing frequency. We constructed a Poisson regression model for each country to calculate prevalence ratios and 95% CIs of factors associated with an increase of testing frequency as a result of self-sampling availability. Overall, 59% (between country range 54.2%-77.2%) of the participants considered that they would test more frequently for HIV if self-sampling was available in their country. In the multivariate analysis, the increase of testing frequency as a result of self-sampling availability was independently associated with reporting a higher number of unprotected anal intercourse events in all countries except for Greece. Independent associations were also observed among GBMSM who were not open about their sex life in Germany, Greece, Portugal, and Spain; those with a lower number of previous HIV tests in Denmark, Greece, Portugal, and Spain; and for those that took their last test more than 3 months previously in Germany, Portugal, Romania, and Spain. In addition, 58.4% (range 40.5%-73.6%) of the participants indicated a preference for learning their result through one-way interaction methods, mainly via email (25.6%, range 16.8%-35.2%) and through a secure website (20.3%, range 7.3%-23.7%). Almost two thirds (65%) of GBMSM indicated preferring one of these methods even if the result was reactive. Availability of HIV self-sampling kits as an additional testing methodology would lead to a much-needed increase of testing frequency, especially for the hidden, high-risk, and undertested GBMSM population. Online-based technologies without any personal interaction were preferred for the communication of the results, even for reactive results.This study was supported by the Consumers, Health and Food Executive Agency (CHAFEA: 20131101) and Acción Estratégica Intramural (PI17CIII/00037). The funding sources were not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.S