GP-support by means of AGnES-practice assistants and the use of telecare devices in a sparsely populated region in Northern Germany – proof of concept

<p>Abstract</p> <p>Background</p> <p>In many rural regions in Germany, the proportion of the elderly population increases rapidly. Simultaneously, about one-third of the presently active GPs will retire until 2010. Often it is difficult to find successors for vacant GP-practices. These regions require innovative concepts to avoid the imminent shortage in primary health care.</p> <p>The AGnES-concept comprises the delegation of GP-home visits to qualified AGnES-practice assistants (AGnES: GP-supporting, community-based, e-health-assisted, systemic intervention). Main objectives were the assessment of the acceptance of the AGnES-concept by the participating GPs, patients, and AGnES-practice assistants, the kind of delegated tasks, and the feasibility of home telecare in a GP-practice.</p> <p>Methods</p> <p>In this paper, we report first results of the implementation of this concept in regular GP-practices, conducted November 2005 – March 2007 on the Island of Rügen, Mecklenburg-Western Pomerania, Germany. This study was meant as a proof of concept.</p> <p>The GP delegated routine home-visits to qualified practice employees (here: registered nurses). Eligible patients were provided with telecare-devices to monitor disease-related physiological values.</p> <p>All delegated tasks, modules conducted and questionnaire responses were documented. The participating patients were asked for their acceptance based on standardized questionnaires. The GPs and AGnES-practice assistants were asked for their judgement about different project components, the quality of health care provision and the competences of the AGnES-practice assistants.</p> <p>Results</p> <p>550 home visits were conducted. 105 patients, two GPs and three AGnES-practice assistants (all registered nurses) participated in the project. 48 patients used telecare-devices to monitor health parameters. 87.4% of the patients accepted AGnES-care as comparable to common GP-care. In the course of the project, the GPs delegated an increasing number of both monitoring and interventional tasks to the AGnES-practice assistants. The GPs agreed that delegating tasks to a qualified practice assistant relieves them in their daily work.</p> <p>Conclusion</p> <p>A part of the GPs home visits can be delegated to AGnES-practice assistants to support GPs in regions with an imminent or already existing undersupply in primary care. The project triggered discussions among the institutions involved in the German healthcare system and supported a reconciliation of the respective competences of physicians and other medical professions.</p

High Temperature Solid Media Thermal Energy Storage for Solar Thermal Power Plants

Solid sensible heat storage is an attractive option for high temperature storage applications regarding investment and maintenance costs. Using concrete as solid storage material is most suitable, as it is easy to handle, the major aggregates are available all over the world and there are no environmentally critical components. Long term stability of concrete has been proven in oven experiments and through strength measurements up to 500 °C. Material parameters and storage performance have been validated in a 20 m³ test module with more than 23 months of operation between 200 and 400 °C and more than 370 thermal cycles. For an up-scaled concrete storage design with 1100 MWh capacity in a modular set-up for a 50 MWel parabolic trough power plant of the ANDASOL-type, about 50,000 m³ of concrete is required and the investment costs are approximately 38 million Euro. The simulation of the annual electricity generation of a 50 MWel parabolic trough power plant with a 1100 MWh concrete storage shows that such plants could operate for about annually, delivering ca. 3,500 full load hours in southern Europe, about 30 % of this electricity is generated by the storage system. This number will further increase, when improved operation strategies are applied. Approaches for further cost reduction using heat transfer structures with high thermal conductivity inside the concrete are analyzed, leading to a 60 % reduction in the number of heat exchanger pipes required. For implementation of the structures, the storage is build up of precast concrete blocks

Solid Media Thermal Storage Development and Analysis of Modular Storage Operation Concepts for Parabolic Trough Power Plants

Cost-effective integrated storage systems are important components for the accelerated market penetration of solarthermal power plants. Besides extended utilisation of the power block the main benefits of storage systems are improved efficiency of components, and facilitated integration into the electrical grids. For parabolic trough power plants using synthetic oil as the heat transfer medium, the application of solid media sensible heat storage is an attractive option in terms of investment and maintenance costs. For commercial oil trough technology, a solid media sensible heat storage system was developed and tested. One focus of the project was the cost reduction of the heat exchanger; the second focus lies in the energetic and exergetic analysis of modular storage operation concepts, including a cost assessment of these concepts. The results show that technically there are various interesting ways to improve storage performance. However, these efforts do not improve the economical aspect. Therefore the tube register with straight parallel tubes without additional structures to enhance heat transfer has been identified as the best option concerning manufacturing aspects and investment costs. The results of the energetic and exergetic analysis of modular storage integration and operation concepts show a significant potential for economic optimisation. An increase of more than 100 % in storage capacity or a reduction of more than factor 2 in storage size and therefore investment cost for the storage system was calculated. A complete economical analysis, including the additional costs for this concept on the solar field piping and control, still has to be performed

COMBINED STORAGE SYSTEM DEVELOPMENTS FOR DIRECT STEAM GENERATION IN SOLAR THERMAL POWER PLANTS

For future parabolic trough plants direct steam generation in the absorber pipes is a promising option for reducing the costs of solar thermal energy. These new solar thermal power plants require innovative storage concepts, where the two phase heat transfer fluid poses a major challenge. A three-part storage system is proposed for the two phase fluid water/steam. Concrete storage is used for the process steps involving transfer of sensible heat – i.e. preheating of water and superheating of steam - while for the two-phase evaporation a phase change material (PCM) storage will be deployed. This technology is currently being tested by DLR and Ed. Züblin AG within the project ITES, funded partly by the German Ministry for the Environment, Nature Conservation and Nuclear Safety. A combined storage solution with a 22 m³ concrete storage test module for superheating of steam and a 8.5 m³ PCM-storage for evaporation of water was build in 2009 in a direct steam test loop, set up at the power plant Litoral of Endesa in Carboneras, Spain. This high temperature storage system has a total capacity of ca. 1000 kWh and is the first demonstration of such a combined storage system for the two phase heat transfer fluid water/steam, details were reported in [Laing et al., 2009]. Cycle testing has started end of 2010. First, cycling tests for each storage unit separately have been performed successfully, showing the expected discharge capacities of ca. 250 kWh for the concrete unit and ca. 720 kWh for the PCM-storage module. System operation in constant pressure mode and sliding pressure mode has been conducted for the PCM-storage. While in the constant pressure mode the peak power of the storage of more than 700 kW could be demonstrated, in the sliding pressure mode a constant power output over almost the whole charge and discharge period could be provided. Combined system operation was also proven in constant pressure and sliding pressure mode, showing good system operability. The paper will describe the storage system and present the test results and evaluation of the single module testing as well as on the combined storage system testing in different operation modes

Life- and person-centred help in Mecklenburg-Western Pomerania, Germany (DelpHi): study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany. New models of healthcare provision need to be developed, tested and implemented on the population level. Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness. These studies have been conducted in different healthcare systems, however, so it is unclear whether these results extend to the specific context of the German healthcare system.</p> <p>The objective of this population-based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home.</p> <p>Methods and study design</p> <p>The study was designed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home (DelpHi cohort). These people are screened for eligibility to participate in a trial of dementia care management (DelpHi trial). The trial is a cluster-randomised, controlled intervention trial with two arms (intervention and control) designed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home. This subsidiary support system is initiated and coordinated by a dementia care manager: a nurse with dementia-specific qualifications who delivers the intervention according to a systematic, detailed protocol. The primary outcome is quality of life and healthcare for patients with dementia and their caregivers. This is a multidimensional outcome with a focus on four dimensions: (1) quality of life, (2) caregiver burden, (3) behavioural and psychological symptoms of dementia and (4) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication. Secondary outcomes include the assessment of dementia syndromes, activities of daily living, social support health status, utilisation of health care resources and medication.</p> <p>Discussion</p> <p>The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs. Qualification requirements will be evaluated, and the results will help to modify existing guidelines and treatment paths.</p> <p>Trial registration</p> <p>NCT01401582</p