Improving primary palliative care – a Delphi consensus study on measures for general practice in Germany

Background The majority of severely ill and dying people in Germany can be administered primary palliative care (PPC) by general practitioners (GP). However, the current provision of PPC does not match the needs of the population. Although several public health strategies aim at strengthening the role of GPs in PPC provision, it remains challenging for GP teams to integrate PPC into their daily routines. Aim A Delphi study with GPs was conducted to achieve consensus on specific measures for improving the integration of PPC into everyday GP practice. Methods The study is part of the junior research project “Primary Palliative Care in General Practice” (ALLPRAX). After having developed, tested and evaluated 26 practical measures for GP practices to improve their PPC, a Delphi consensus study among GPs took place. In 2020, 569 GPs were asked to rate the relevance and feasibility of the measures on a 4-point Likert scale via an anonymous online questionnaire. Consensus was defined as a sum percentage of ‘strongly agree’ and ‘somewhat agree’ responses ≥75% after two rounds. Between these rounds, measures that were not consented in the first round were adapted in light of respondents’ free text comments and suggestions. Results The response rate was 11.3% in round 1 (n = 64) and 53.1% in round 2 (n = 34). From the initial n = 26 measures, n = 20 measures achieved consensus and were included in the final intervention package. The consented measures pertained to four main topics: advance care planning with patients, consulting and informing patients and family caregivers, GP office organisation and continuing education. N = 6 measures did not achieve consensus, predominantly due to time and workload constraints. Conclusion The consented measures provide valuable support to improve the provision of PPC by GPs. They can be used freely and flexibly, according to the needs of individual GP teams, and are thus suitable for implementation nationwide. Trial registration The study was registered in the German Clinical Trials Register (Registration N° DRKS00011821; 4 December 2017; https://apps.who.int/trialsearch/) and the German Register of Health Care Research (Registration N° VfD_ALLPRAX_16_003817; 30 March 2017).

Terrie Fox Wetle Award (2021): Advancing multidisciplinary health services science: Developments in a Dementia-Focused Program of Research

The Terrie Fox Wetle Rising Star Award in health Services and Aging Research is an award named in honor of Fox Wetle, PhD, who is internationally recognized for her contributions to aging, public health, and health care research. The award recognizes health services researchers in early or middle-career phases who have made significant contributions that embody the value of multidisciplinary health services science and are likely to have a sustained, high impact on practice and research. This aware lecture will be presented by the 2021 Award Recipient, Andrea Gilmore-Bykovskyi, PhD, RN, and will highlight emergent findings and foci in her dementia-focused health services research program. In particular, the award lecture will discuss progress in investigating social and behavioral communication patterns among individuals with moderate to advanced dementia; and the role of temporally situated observational measures and inclusion of persons with dementia and their caregivers in this line of research. The lecture will conclude with a discussion of next steps for this area of investigation surrounding assessment of episodes of lucidity in advanced dementia; and considerations for strengthening progress in outcome evaluation among persons living with dementia through multidisciplinary and community-informed health services research.

Serum N-Glycome Diversity in Teleost and Chondrostrean Fishes

Recent advances in carbohydrate chemistry, chemical biology, and mass spectrometric techniques have opened the door to rapid progress in uncovering the function and diversity of glycan structures associated with human health and disease. These strategies can be equally well applied to advance non-human health care research. To date, the glycomes of only a handful of non-human, non-domesticated vertebrates have been analyzed in depth due to the logistic complications associated with obtaining or handling wild-caught or farm-raised specimens. In contrast, the last 2 decades have seen advances in proteomics, glycoproteomics, and glycomics that have significantly advanced efforts to identify human serum/plasma biomarkers for various diseases. In this study, we investigated N-glycan structural diversity in serum harvested from five cultured fish species. This biofluid is a useful starting point for glycomic analysis because it is rich in glycoproteins, can be acquired in a sustainable fashion, and its contents reflect dynamic physiologic changes in the organism. Sera acquired from two chondrostrean fish species, the Atlantic sturgeon and shortnose sturgeon, and three teleost fish species, the Atlantic salmon, Arctic char, and channel catfish, were delipidated by organic extraction and the resulting protein-rich preparations sequentially treated with trypsin and PNGaseF to generate released N-glycans for structural analysis. Released N-glycans were analyzed as their native or permethylated forms by nanospray ionization mass spectrometry in negative or positive mode. While the basic biosynthetic pathway that initiates the production of glycoprotein glycan core structures is well-conserved across the teleost fish species examined in this study, species-specific structural differences were detected across the five organisms in terms of their monosaccharide composition, sialylation pattern, fucosylation, and degree of O-acetylation. Our methods and results provide new contributions to a growing library of datasets describing fish N-glycomes that can eventually establish species-normative baselines for assessing N-glycosylation dynamics associated with pathogen invasion, environmental stress, and fish immunologic responses.

Management strategy of healthcare organizations. PDRQ–9 method

The main source of success for a customer-centric organization is the ability to identify its customers, identify their needs, and use that information to develop a customer-centric strategy. In this regard, there is a widespread change in attitudes toward the construction of management in organizations. Whereas previously the competitiveness of an organization could be measured by its financial performance, now the intellectual potential of an organization is at the forefront. As the role of the patient in the health care system has intensified, the importance of patient participation has received increasing attention and has become central to health care research. In this regard, in today’s environment, the foundation of success in the treatment and delivery of professional care in medicine is primarily the degree of patient satisfaction. Patient-centered care acts as a new paradigm for the development of the health care system, which is characterized by a shift in the center of gravity to the patient. In this regard, in the field of health care, the relationship between the patient and the doctor, as perceived by the patient, is one of the main elements of the methodology of scientific research. The purpose of this article is to review and analyze the results of the PDRQ–9, which assesses the patient-physician relationship. The PDRQ–9 provides researchers with a brief assessment of the therapeutic aspects of the patient-physician relationship in the primary care setting. It is a valuable tool for research and practice purposes that includes monitoring the patient-doctor relationship.

Avaliação, Monitoramento e Melhoria da Qualidade na APS

Esta nota técnica se insere no conjunto de ações desenvolvidas pela Rede de Pesquisa em Atenção Primária à Saúde e apresenta sua posição sobre avaliação, monitoramento e melhoria da qualidade na APS. Em um contexto de grave crise sanitária que desnuda as dificuldades institucionais, financeiras e operativas de resposta à situação de saúde, situa o debate e traz proposições que fortalecem uma prática avaliativa como instrumento essencial para o aprimoramento e fortalecimento de ações que potencializam o papel da APS no contexto do SUS. Estas notas abordam: a avaliação no contexto da APS em uma perspectiva histórica e institucional que situa sua relevância na própria trajetória do SUS. A importância de compreender os conceitos, métricas e indicadores e apropriá-los ao debate qualificado no âmbito da APS. Uma posição para a Rede APS em termos de desafios e proposições, visando a uma APS mais forte que nunca. Palavras-chave: APS, Avaliação, Monitoramento, Qualidade. Abstract This technical report is part of the set of actions developed by the Primary Health Care Research Network and presents its position on evaluation, monitoring and quality improvement in PHC. In a context of serious health crisis that exposes the institutional, financial and operational difficulties in responding to the health situation, it situates the debate and brings proposals that strengthen an evaluative practice as an essential instrument for the improvement and strengthening of actions that enhance the role of PHC in the context of the SUS. These notes address: the assessment in the context of PHC in a historical and institutional perspective that locates its relevance in the trajectory of the SUS. The importance of understanding the concepts, metrics and indicators and appropriating them to the qualified debate within the PHC. A position for the APS Network in terms of challenges and propositions, aiming for a stronger APS than ever. Keywords: PHS, assessing, monitoring, quality.