ATME-Needs, requirements and cross-sectoral patient journeys of patients with out-of-hospital mechanical ventilation and intensive care in outpatient settings: study protocol for an observational study.

INTRODUCTION: An increasing number of tracheotomised and/or ventilated patients with high-cost out-of-hospital intensive care needs and, at the same time, a decreasing number of healthcare professionals inevitably lead to challenges in the care of this patient population. In addition, little is known about this population, their health restrictions, needs, patient journeys, care structures and processes. The project 'Needs, requirements and cross-sectoral care pathways of out-of-hospital ventilated intensive care patients' (ATME) aims to analyse these aspects and explore current care structures to inform further development of care in line with patients' needs and requirements. METHODS AND ANALYSIS: Qualitative and quantitative methods will be used. In preparation of a semistandardised survey, exploratory interviews will be conducted with tracheotomised and/or ventilated patients with out-of-hospital intensive care needs (TVPOI) (n=15), nursing care providers (n=30), outpatient medical centres, as well as outpatient medical, medical technology and therapeutic care providers (n=35). Three semistandardised survey questionnaires for TVPOI (n=2,000) will be developed and conducted with nursing care facilities (n=250) and outpatient medical centres for mechanical ventilation (n=25). Content analyses will be conducted for qualitative data; survey data will be analysed descriptively. In addition, healthcare claims data will be analysed descriptively to provide information on patient journeys. Three result workshops and one consensus conference will be carried out with representatives of the relevant target groups to analyse the suitability of care structures and to develop recommendations for action to improve TVPOI. ETHICS AND DISSEMINATION: The ATME study received a positive vote from the Ethics Committee of the Osnabrück University of Applied Sciences and is registered in 'Deutsches Register Klinischer Studien (DRKS)' (registration number: DRKS00030891). The study results will be presented at national conferences and in relevant peer-reviewed journals. Additionally, study results will be published by the funding institution (the Innovation Committee of the Federal Joint Committee) on their website.

RAVER1 hinders lethal EMT and modulates miR/RISC activity by the control of alternative splicing.

The RAVER1 protein serves as a co-factor in guiding the polypyrimidine tract-binding protein (PTBP)-dependent control of alternative splicing (AS). Whether RAVER1 solely acts in concert with PTBPs and how it affects cancer cell fate remained elusive. Here, we provide the first comprehensive investigation of RAVER1-controlled AS in cancer cell models. This reveals a pro-oncogenic role of RAVER1 in modulating tumor growth and epithelial-mesenchymal-transition (EMT). Splicing analyses and protein-association studies indicate that RAVER1 guides AS in association with other splicing regulators, including PTBPs and SRSFs. In cancer cells, one major function of RAVER1 is the stimulation of proliferation and restriction of apoptosis. This involves the modulation of AS events within the miR/RISC pathway. Disturbance of RAVER1 impairs miR/RISC activity resulting in severely deregulated gene expression, which promotes lethal TGFB-driven EMT. Among others, RAVER1-modulated splicing events affect the insertion of protein interaction modules in factors guiding miR/RISC-dependent gene silencing. Most prominently, in all three human TNRC6 proteins, RAVER1 controls AS of GW-enriched motifs, which are essential for AGO2-binding and the formation of active miR/RISC complexes. We propose, that RAVER1 is a key modulator of AS events in the miR/RISC pathway ensuring proper abundance and composition of miR/RISC effectors. This ensures balanced expression of TGFB signaling effectors and limits TGFB induced lethal EMT.

[Homecare arrangements: examining the use of support services in relation to socioeconomic status]. / Häusliche Pflegearrangements: Untersuchung der Inanspruchnahme von Unterstützungsleistungen im Zusammenhang mit dem sozioökonomischen Status.

BACKGROUND: National and international findings indicate that homecare arrangements are influenced by socioeconomic factors. Demographic and social developments justify the assumption of an increasing number of people in need of care from resource-pour groups and therefore a continuously increasing importance of home-based long-term care. OBJECTIVE: It is examined whether income and education of people in need of care and their caregivers are related to the use of support services in homecare arrangements. MATERIAL AND METHODS: Quantitative secondary data analysis of a survey among members of the social association VdK (Sozialverband VdK). The statistical evaluation includes descriptive analyses as well as the investigation of correlations between socioeconomic characteristics and characteristics of the care arrangement. RESULTS: A correlation between income and the use of support services exists regarding so-called 24-hour care, which is more common with high incomes. Other income effects can be seen in the extent to which care services and home help services are used and in measures to adapt the home environment. A higher level of education is related to an increased use of counselling services. The assessment of the care situation is more negative the lower the income. CONCLUSIONS: The results point out that phenomena of social inequality in care exist and that the options for shaping homecare are influenced by socioeconomic factors. The study also shows challenges in dealing with social inequality and provides orientation for further research, which is becoming increasingly important in view of current trends.

What Went Wrong in eMedCare? Formative Evaluation of an IT Project in Primary Care in Two Rural Districts.

INTRODUCTION: The interaction between nurses and physicians in the primary care setting is challenging with regard to structural, process and technical barriers. In order to overcome these barriers, the eMedCare project was launched and a commercial system was implemented. OBJECTIVE: This study aimed at a formative evaluation of the project. The findings should be used retrospectively to understand the failure of the project. METHODS: To this end, two rounds of qualitative interviews with 10 respectively 8 healthcare providers were performed. RESULTS: The interviews revealed a mixed benefit. Difficulties arose because the initial aim to monitor patients shifted towards improving the communication between the providers, partly due to the poor usability of the monitoring system. Additional workload was imposed because the system was not interoperable with the institutional IT systems. CONCLUSION: Projects with an unclear or shifting vision and focus seem to be susceptible to failure. The secure communication applications could have been realised on the intended scale if the national Telematikinfrastruktur had been in place.