Collaboration of general practitioners and gynaecologists in outpatient health care for women aged 50 and over in Germany

Hintergrund Die Frauengesundheit von älteren Frauen ist vor allem in ländlichen Gebieten Deutschlands vor dem Hintergrund einer steigenden Anzahl von Frauen ab 50 Jahren und einer drohenden Unterversorgung bei medizinischen Leistungen zu betrachten. Einflüsse auf die Primärversorgung wie Delegation, Telemedizin oder interdisziplinäre Praktiken wurden in Studien beschrieben. Zu interdisziplinären Praktiken zählen Vernetzung und Zusammenarbeit von Fachärztinnen/Fachärzten (FÄ) in der ambulanten Primärversorgung. In Bezug auf die Gesundheit älterer Frauen berichteten Hausärztinnen/Hausärzte (HÄ) sowie Gynäkologinnen/Gynäkologen (Gyn) als zuständige FÄ-Gruppen in dieser Arbeit über die Versorgungssituation sowie über ihre Vernetzung und Zusammenarbeit. Darüber hinaus wurden Einflussfaktoren auf die Zusammenarbeit wissenschaftlich untersucht. Methodik Zwischen März und Juni 2018 wurde im Stadtstaat Berlin sowie in den Flächenländern Brandenburg und Mecklenburg-Vorpommern im Rahmen einer repräsentativen postalischen Befragung eine randomisierte Auswahl von 3.514 HÄ (67 % von 5.265 HÄ) und 1.031 Gyn in einer Vollerhebung quantitativ unter Verwendung eines selbst entwickelten und mit Expertinnen/Experten pilotierten Fragebogens befragt. Deskriptive Analysen wurden zur Darstellung von Versorgungssituation, formeller und informeller Vernetzung sowie zu 13 Aspekten der Zusammenarbeit genutzt. Die Ermittlung von Einflussfaktoren auf die Zusammenarbeit erfolgte jeweils mittels multipler logistischer Regressionen, adjustiert nach Alter und Geschlecht. Ergebnisse Der Fragebogen wurde von 1.389 FÄ (861 HÄ, 528 Gyn) ausgefüllt zurückgesendet, was einer Responserate von 31 % (25 % HÄ, 51 % Gyn) entsprach. Responder waren im Durchschnitt 54,4 Jahre alt, eher weiblich (72 %) und stammten aus den Flächenländern (55 %). Die gynäkologische Versorgungssituation wird von 30 % aller Responder als bedroht angesehen. Insgesamt gaben 68 % der FÄ an vernetzt zu sein, jedoch nur 10 % in formalen Strukturen. Haupteinflussfaktoren auf die engere Zusammenarbeit von HÄ und Gyn war das Praktizieren in einem Flächenland sowie die Angabe, Teil eines Netzwerks zu sein. So war die Zufriedenheit mit der Zusammenarbeit in Flächenländern höher als im Stadtstaat (Odds Ratio [OR] = 1,7, 95 %iges Konfidenzintervall [CI] = 1,3-2,1) sowie bei HÄ und Gyn als Teil eines informellen Netzwerks im Vergleich mit HÄ und Gyn ohne informelles Netzwerk (OR = 2,7, CI = 2,1-3,4). Schlussfolgerungen Die Versorgungssituation wird in Flächenländern und Stadtstaat im gleichen Maße als bedroht angesehen. Zusammenarbeit ist systematisch besser ausgeprägt zwischen ambulant tätigen HÄ und Gyn in Flächenländern sowie zwischen FÄ, die sich einem Netzwerk zugehörig fühlen. Eine stärkere informelle und formale Vernetzung könnte die Zusammenarbeit zwischen HÄ und Gyn verbessern, die Kontinuität und Sicherheit der ambulanten ärztlichen Versorgung älterer Frauen steigern und die Zufriedenheit der FÄ stärken.Background The health of elderly women, especially in rural areas of Germany, has to be considered within the context of an increasing number of women aged 50 and over and a threatening shortage of medical services. Influences on the primary healthcare such as delegation, telemedicine or interdisciplinary practices have been described in previous studies. Interdisciplinary practices include networking and collaboration between medical specialists in outpatient primary healthcare. Being the responsible medical specialists in this study, general practitioners (GPs) and gynaecologists (Gyns) reported on the healthcare situation as well as on their networking and collaboration. In addition, factors influencing these collaborations were scientifically investigated. Methods Between March and June 2018, a randomised selection of 3,514 GPs (67 % of 5,265 GPs) and 1,031 Gyns from the city state of Berlin and the territorial states of Brandenburg and Mecklenburg-Western Pomerania were surveyed quantitatively with a representative postal survey using a self-developed questionnaire, which was pilot-tested with the help of experts. Descriptive analyses were used to describe the healthcare situation, formal and informal networking and 13 aspects of the collaboration among GPs and Gyns. Factors influencing collaboration were determined using multiple logistic regressions, adjusted for age and gender. Results The questionnaire was completed and returned by 1,389 physicians (861 GPs, 528 Gyns), which corresponded to a response rate of 31 % (25 % GPs, 51 % Gyns). Responders were on average 54.4 years old, more likely to be female (72 %) and working in the territorial states (55 %). The gynaecological care situation was considered threatened by 30 % of all responders. Overall, 68 % of the Gyns stated that they were members of a network, but only 10 % in formal structures. The main factors influencing a closer collaboration between GPs and Gyns included practising in a territorial state and being member of a network. Satisfaction regarding collaboration was higher in territorial states than in the city state (odds ratio [OR] = 1.7, 95 % confidence interval [CI] = 1.3-2.1) and for GPs and Gyns that were members of an informal network compared to those GPs and Gyns without an informal network (OR = 2.7, CI = 2.1-3.4). Conclusions The healthcare situation is considered to be threatened to the same extent in the territorial states and the city state. Collaboration is systematically better developed between outpatient GPs and Gyns in the territorial states and between those who see themselves as members of a network. Stronger informal and formal networking could improve collaboration between GPs and Gyns, increase the continuity and safety of outpatient medical care for elderly women and increase the satisfaction of the specialists

Support for General Practitioners in the Care of Patients with Complex Needs: A Questionnaire Survey of General Practitioners in Berlin

OBJECTIVES Because of demographic changes, new models of care are important for supporting general practitioners in the care of patients with complex needs. This study addresses the question of the type of support that is requested by general practitioners working in Berlin. METHODS All general practitioners working in Berlin (n=2354) were asked between August and September 2018 to return a questionnaire by post which has been developed for this study. Questions addressed support needs as well as support models within the practice (delegation, substitution) and outside the practice (social worker, navigator, community care points). Data were analysed descriptively and by exploratory multivariate analysis to show the influence of practice and doctor characteristics on the preference of support models (age, gender, location of the practice, type of practice, working hours). RESULTS A total of 557 questionnaires (response rate 23.7%) were included in the analysis. Need for support was seen particularly for administrative, coordinative and organisational tasks and for advice on social issues. The majority of the study participants approved delegation and substitution. In their view, it was conceivable to get support from professionals or institutions outside their practice, such as mobile care services, community care points, social workers or navigators. Particularly younger and female doctors working in group practices were open for cooperative care models integrating other health professions. CONCLUSIONS There is unused potential for delegation and cooperation within existing structures. Further research should investigate the acceptance and feasibility of different support models.ZIEL Vor dem Hintergrund der demografischen Entwicklung werden zukünftig Versorgungsmodelle wichtig, die Hausärzte in der Versorgung von Patienten mit komplexem Bedarf unterstützen können. Die vorliegende Fragebogenstudie untersucht, welche Formen der Unterstützung sich Berliner Hausärzte wünschen. METHODIK Alle niedergelassenen Hausärzte Berlins (n=2354) wurden im Zeitraum August bis September 2018 postalisch gebeten, einen für die Fragestellung entwickelten Fragebogen auszufüllen. Die Fragen adressierten den Unterstützungsbedarf sowie verschiedene Unterstützungsmodelle. Es wurde zwischen Unterstützungsmöglichkeiten innerhalb (Delegation, Substitution) und außerhalb (Sozialarbeiter, Versorgungslotsen, Pflegestützpunkt) von Hausarztpraxen differenziert. Die Auswertung erfolgte deskriptiv, sowie explorativ multivariat in Bezug auf Zusammenhänge zwischen der Zustimmung zu Unterstützungsmodellen und Praxis- bzw. Arztcharakteristika (Alter, Geschlecht der Ärzte, Lage der Praxis, Praxisform, Arbeitszeit). ERGEBNISSE 557 Fragebögen (Response Rate 23,7%) wurden ausgewertet. Unterstützungsbedarf wurde v. a. für administrative, koordinative und organisatorische Tätigkeiten gesehen sowie für soziale und sozialrechtliche Fragestellungen. Ein Großteil der teilnehmenden hausärztlichen Praxen steht sowohl der Delegation als auch der Substitution ärztlicher Leistungen positiv gegenüber. Darüber hinaus ist für Hausärzte auch Unterstützung außerhalb der eigenen Praxis durch Mitarbeiter eines ambulanten Pflegedienstes, eines Pflegestützpunktes, oder durch Sozialarbeiter und Versorgungslotsen vorstellbar. Insbesondere jüngere und weibliche Hausärzte sowie diejenigen, die bereits in kooperativen Praxis-Strukturen tätig sind, sind offen für kooperative Ansätze unter Einbeziehung weiterer Gesundheitsberufe. SCHLUSSFOLGERUNG Es bestehen noch unzureichend genutzte Potenziale der Delegation und der Kooperation mit bestehenden Strukturen. Die hier befragten Berliner Hausärzte zeigten ein hohes Maß an Zustimmung zu Delegation und Substitution. Aber auch Gesundheitsberufe und Institutionen außerhalb der eigenen Praxis könnten die Hausärzte stärker unterstützen. Insbesondere für administrative und koordinative Tätigkeiten sowie für soziale und sozialrechtliche Fragestellungen wird Unterstützungsbedarf gesehen. In weiteren Untersuchungen sollte die Akzeptanz unter der Ärzteschaft und die Machbarkeit unterschiedlicher Modelle weiter untersucht werden

Stereotypical Chronic Lymphocytic Leukemia B-Cell Receptors Recognize Survival Promoting Antigens on Stromal Cells

Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world. Survival of CLL cells depends on their close contact with stromal cells in lymphatic tissues, bone marrow and blood. This microenvironmental regulation of CLL cell survival involves the stromal secretion of chemo- and cytokines as well as the expression of adhesion molecules. Since CLL survival may also be driven by antigenic stimulation through the B-cell antigen receptor (BCR), we explored the hypothesis that these processes may be linked to each other. We tested if stromal cells could serve as an antigen reservoir for CLL cells, thus promoting CLL cell survival by stimulation through the BCR. As a proof of principle, we found that two CLL BCRs with a common stereotyped heavy chain complementarity-determining region 3 (previously characterized as “subset 1”) recognize antigens highly expressed in stromal cells – vimentin and calreticulin. Both antigens are well-documented targets of autoantibodies in autoimmune disorders. We demonstrated that vimentin is displayed on the surface of viable stromal cells and that it is present and bound by the stereotyped CLL BCR in CLL-stroma co-culture supernatant. Blocking the vimentin antigen by recombinant soluble CLL BCR under CLL-stromal cell co-culture conditions reduces stroma-mediated anti-apoptotic effects by 20–45%. We therefore conclude that CLL BCR stimulation by stroma-derived antigens can contribute to the protective effect that the stroma exerts on CLL cells. This finding sheds a new light on the understanding of the pathobiology of this so far mostly incurable disease

Collaboration amongst general practitioners and gynaecologists working in primary health care in Germany: a cross-sectional study

Aim: This cross-sectional study is the first one to explore the collaboration of the influencing factors thereof amongst general practitioners (GPs) and gynaecologists (Gyns) working in primary care in urban and rural settings in Germany. Background: The number of women aged >= 50 years is predicted to increase in the next years in Germany. This coincides with the ageing of primary care specialists providing outpatient care. Whereas delegation of tasks to nurses as a form of interprofessional collaboration has been the target of recent studies, there is no data regarding collaboration amongst physicians in different specialisations working in primary care. We explored collaboration amongst GPs and Gyn regarding the healthcare provision to women aged >= 50 years. Methods: A quantitative postal survey was administered to GPs and Gyns in three federal states in Germany, focusing on care provision to women aged >= 50 years. A total of 4545 physicians, comprising 3514 GPs (67% of the total GP population) randomly selected, and all 1031 Gyns practicing in these states received the postal survey in March 2018. A single reminder was sent in April 2018 with data collection ending in June 2018. Multiple logistic regressions were performed for collaboration, adjusted by age and sex, alongside descriptive methods. Findings: The overall response rate was 31% (1389 respondents): 861 GPs (25%) and 528 Gyns (51%), with the mean respondent age being 54.4 years. Seventy-two per cent were female. Key competencies of collaboration are associated with working in rural federal states and with network participation. Physicians from rural states [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.2, 1.9] and physicians in networks (OR = 3.0, CI = 2.3, 3.9) were more satisfied with collaboration. Collaboration to deliver services for women aged >= 50 years is more systematic amongst GPs and Gyns who are members of a network; increased networking could improve collaboration, and ultimately, outcomes too

Downsizing Class II Lasso Peptides:Genome Mining-Guided Isolation of Huascopeptin Containing the First Gly1-Asp7 Macrocycle

This work was financially supported by the CONICYT PFCHA/DOCTORADO BECAS CHILE/2016-21160585 fellowship and CONICYT Basal Centre Grant for the Centre for Biotechnology and Bioengineering, CeBiB (FB0001). S.A.J. thanks the University of Aberdeen for providing an Elphinstone Scholarship. We thank the Scottish High-Field NMR (SHF NMR) Centre at the University of Edinburgh for NMR experiments. We also thank Dr. Paul Herron (Strathclyde Institute of Pharmacy and Biomedical Sciences) for genome sequencing. Additionally, we thank Kirsti Helland, Marte Albrigsten, and Jeanette Andersen (University of Tromsø - The Arctic University of Norway) for conducting biologicalassays. Finally, we thank Dr. Imen Nouioui and Dr. Cristina Dorador for their feedback during manuscript preparation.Peer reviewedPostprin

Chaxapeptin, a Lasso Peptide from ExtremotolerantStreptomyces leeuwenhoekiiStrain C58 from the Hyperarid Atacama Desert.

Lasso peptides are ribosomally synthesized and post-translationally modified peptides (RiPPs) that possess a unique “lariat knot” structural motif. Genome mining-targeted discovery of new natural products from microbes obtained from extreme environments has led to the identification of a gene cluster directing the biosynthesis of a new lasso peptide, designated as chaxapeptin 1, in the genome of Streptomyces leeuwenhoekii strain C58 isolated from the Atacama Desert. Subsequently, 1 was isolated and characterized using high-resolution electrospray ionization mass spectrometry and nuclear magnetic resonance methods. The lasso nature of 1 was confirmed by calculating its nuclear Overhauser effect restraint-based solution structure. Chaxapeptin 1 displayed a significant inhibitory activity in a cell invasion assay with human lung cancer cell line A549

Chaxapeptin, a Lasso Peptide from Extremotolerant <i>Streptomyces leeuwenhoekii</i> Strain C58 from the Hyperarid Atacama Desert

Lasso peptides are ribosomally synthesized and post-translationally modified peptides (RiPPs) that possess a unique “lariat knot” structural motif. Genome mining-targeted discovery of new natural products from microbes obtained from extreme environments has led to the identification of a gene cluster directing the biosynthesis of a new lasso peptide, designated as chaxapeptin <b>1</b>, in the genome of <i>Streptomyces leeuwenhoekii</i> strain C58 isolated from the Atacama Desert. Subsequently, <b>1</b> was isolated and characterized using high-resolution electrospray ionization mass spectrometry and nuclear magnetic resonance methods. The lasso nature of <b>1</b> was confirmed by calculating its nuclear Overhauser effect restraint-based solution structure. Chaxapeptin <b>1</b> displayed a significant inhibitory activity in a cell invasion assay with human lung cancer cell line A549