Interdisciplinary care programme to improve self-management for cancer patients undergoing stem cell transplantation: a prospective non-randomised intervention study.

The purpose of this single-centre prospective non-randomised study was to evaluate the effectiveness of an interdisciplinary care programme to enhance self-management in patients with haematopoietic stem cell transplantation (HSCT). Patients undergoing HSCT, aged >14 years with informed consent were recruited (n = 79). Patients in the intervention group (IG) received standard care plus the SCION-HSCT intervention to counteract three problems after HSCT: muscle weakness, oral mucositis and malnutrition. Control group patients received standard care. Primary endpoint was global health-related quality of life (HRQoL) at discharge (EORTC QLQ C30 v. 3.0). Baseline characteristics were balanced between both groups, except physical performance (ECOG) being significantly lower for patients of the IG. At discharge, no group differences could be seen regarding HRQoL. Non-confirmatory post hoc analyses showed for patients of the IG a shorter duration of hospitalisation (MD -10.90; 95% CI -18.05 to -3.75) and increased activity during hospitalisation (MD 2.44; 95% CI 1.27-3.61). In conclusion, clinical effectiveness of the intervention could not be proven with respect to the aspired improvement of HRQoL. However, the nurse-led interdisciplinary caring programme could be carried out in every day ward routine. Further research should focus on working mechanisms of complex interventions aiming to improve HRQoL of patients undergoing HSCT.

[Appraisal of Educational Programmes and Qualifications of Health Occupations/Professions: A European Comparison - Main Results and Conclusions]. / Bestandsaufnahme der Ausbildung in den Gesundheitsfachberufen im europäischen Vergleich (GesinE) - zentrale Ergebnisse und Schlussfolgerungen.

INTRODUCTION: This is about some results of a study called "Appraisal of the educational programmes and qualifications of health professions: a European Comparison" (in short: GesinE). It was carried out in the years 2009-2013, commissioned by the BMBF and supported by the BIBB. It is focussed on Germany, France, Great Britain, the Netherlands and Austria. The objectives have been (i) an inventory and comparative international synoptic presentation of education programmes of 16 health professions, (ii) a comparative international qualification analysis for the professions of radiographer, physiotherapist and nurse and (iii) the exposure of key aspects of the health-care and education systems in the compared countries. METHODS: This is a comparative multi-sectional study for which a mixed methods approach with qualitative and quantitative elements was used. RESULTS: According to the results of this study it is necessary that current qualification paths and competence profiles of the health professions are developed continuously in Germany. In this process the German education and the secondary education sector should not be underrated. At the same time the results suggest that there are advantages in some aspects in the academic education (which is the norm for most of the analysed professions in the surveyed countries) compared to the existing education programmes in the secondary sector. This in particular applies to the competence for finding and transferring scientific knowledge into practice and for implementing reflected processes for decision making. CONCLUSIONS: The results improve the basis of the current debate in Germany about the development and reorganisation of the profiles of health professions and their qualification in a European context.

[Symptom experience of patients after allogenic renal transplantation]. / Das Symptomerleben von Patienten nach allogener Nierentransplantation.

BACKGROUND: Quality of life and medication adherence of patients after renal transplantation (RTx) is most affected by problems associated with immunosuppressive symptoms. However, these problems are often underestimated in frequency and level of distress by professionals involved in transplantation. The aim of this study was to determine symptom occurrence and distress associated with current immunosuppressive medication following RTx. METHOD: A cross-sectional study was conducted to assess symptom experience using the Modified Transplant Symptom Occurrence and Symptom Distress Scale-Revised 59 with bivariate subgroup analysis. RESULTS: 605 renal transplant recipients completed the survey. The most common symptoms were dry skin, erectile problems, bruises, muscle weakness and tiredness. The erectile problems, menstrual problems, sores or warts around genitals, feelings of anxiety and joint pain appeared to be the most distressing symptoms. A significantly higher level of symptom prevalence and distress was associated with a number of sociodemographic, disease-related and drug-related factors. CONCLUSION: The study results increase awareness for a careful symptom assessment and provide the basis for strategies to control symptoms. That should lead to improved quality of life and medication adherence with long patient and graft survival.

[Self-management support for patients with chronic obstructive pulmonary disease in ambulatory care--an observational study]. / Selbstmanagementförderung bei Patienten mit chronisch obstruktiver Lungenerkrankung im ambulanten Umfeld--eine Beobachtungsstudie.

This cross-sectional study focuses on the status of COPD-related fears and impairments of adult patients receiving ambulant care as well as their use of self-management strategies. On the basis of the COPD Clinical Questionnaire, COPD Disability Index, COPD Assessment Test and the COPD Anxiety Questionnaire, COPD-dependent fears and impairments were determined in a convenience sample. Furthermore, data on important characteristics of the illness experience were gathered by semi-standardised interviews. Altogether, 80 patients (average age: 67.1 ± 8.5 years) took part in the quantitative interviews. In addition, 10 patients (average age: 68.2 ± 4.1 years) took part in qualitative interviews. Results showed that there were disease-related impairments in the areas of respiration, recovery and physical stress as well as in family and domestic obligations. Furthermore, illness-dependent fears had a high relevance in the study population. The management of COPD-related fears and taking into consideration information and counseling needs of these patients are important intervention approaches. On the basis of the presented results, evidence-based, multi-disciplinary, and disease-, situation- and above all, patient' needs-related interventions could be planned to support patients in self-management skills.

[General practitioner-centred health-care in Germany. The general practitioner as gatekeeper]. / Hausarztzentrierte Versorgung in Deutschland. Der Hausarzt als Lotse?

In many countries, the gatekeeper system in health care has been existent for several years. The health reform 2004 has strengthened the position of the general practitioner (GP) in German health care. The introduction of the so-called general practitioner programmes (Hausarztprogramme) represents a new form of health care. The GP is credited with a gate-keeping function. The aim of GP-centred care is to avoid expensive double check-ups and specialist consultations which are not necessary from a medical point of view. Optimisation and co-operation of people and institutions within the health care system are also intended. The GP programme offers advantages for both parties. The position of the GPs is being strengthened. For example, the insured have fewer expenses, shorter waiting times at the GP practice and benefit of the co-ordination of more complex treatments by the GP. Regarding this topic, a postal survey with members of a compulsory health insurance fund interviewed 962 participants of a GP programme and 644 non-participants (control group). The study's results show that the GP's gatekeeper function is accepted by most of the insured, but that there is still a need to optimise the daily implementation of GP-centred care.

Intraductal carcinoma of the breast: follow-up after biopsy only.

Twenty-eight women with ductal carcinoma in situ (DCIS) of the breast treated by biopsy only were identified in a histologic review of 11,760 biopsies performed between 1950 and 1968. Seven of the 25 women followed for more than three years developed invasive breast carcinoma, all in the same breast with a previously detected DCIS. Average follow-up interval for the 18 women not developing invasive carcinoma was 16 years. The invasive carcinomas presented clinically from three to ten years (average, 6.1) after the biopsies demonstrating DCIS. Four women with invasive carcinoma developed distant metastases following mastectomy. This study suggests that 28% of women treated with biopsy only for DCIS presenting as an incidental histologic finding will develop invasive carcinoma in a follow-up period of approximately 15 years.