The complex intervention day hospice - a quality-assured study on the implementation, realization, and benefits with model character for Germany (IMPULS) using the example of "Day hospice Adiuvantes".

BACKGROUND: Currently, a conclusive experience on the uniform implementation and benefits of day hospice structures and interventions is lacking in Germany. The following questions should be clarified: (1) Which structural conditions and interventional measures should be established in day hospices from the point of view of patients, relatives, and specialist staff?; (2) Are the planned structures or interventions feasible and implementable under real conditions and accepted by patients, relatives, and staff?; (3) How can a final implementation and intervention catalog for day hospices be designed?; (4) Is this final catalog of services feasible, reasonable, economical, and effective under everyday conditions in day hospices? METHODS: We planned to perform a multistage investigation, guided by the Medical Research Council Framework for the development and evaluation of complex interventions. In Stage 1, an initial theoretical construct on structures and interventions will be established through an extensive literature and guideline review on day hospices and through qualitative interviews. In a nominal group process, we will create a catalog of offers. In Stage 2, feasibility testing is conducted in a single-day hospice under real-life conditions using quantitative quality indicators and qualitative interviews. Structures and interventions can be adapted here if necessary. In a second nominal group process, a final structure and offer catalog is created, which is then implemented in Stage 3 in the day hospice under investigation and evaluated under real daily conditions through a process and effectiveness test. For this purpose, qualitative and quantitative quality indicators will be used and a comparative cohort of patients who are not cared for in the day hospice - but in the same network structure (oncology-palliative care network Lower Bavaria) - is examined. DISCUSSION: Finally, the initial statements on the reasonable and realizable structures or interventions in day hospices and their benefits in daily real-life conditions as well as possible optimization processes shall be made. TRIAL REGISTRATION: The study was retrospectively registered in the German Clinical Trials Register (DRKS-ID DRKS00031613, registration date April 04, 2023) and the display portal of the Center for Clinical Trials of the University Hospital Regensburg (Z-2022-1734-6, registration date July 01, 2023).

[Onko-Nexus: A Bavarian "Caretaker Project" to Overcome the Interface Outpatient/Hospitalized Division - Three-Year Results]. / Onko-Nexus: Ein bayerisches "Kümmererprojekt" zur Überwindung der Schnittstelle ambulanter/stationärer Sektor ­ die drei Jahresergebnisse.

The Onko-Nexus ("Caretaker-Project"), sponsored by the Bavarian Ministry for Health and Nursing, is dedicated to improving the outpatient/hospitalized care interface issue for patients with highly complex malignant diseases requiring inpatient care in a university hospital. A total of 26 patients were recruited during the 3-year period of the project. The patients were managed and supported by 2 "Caretakers" (physician assistants), one from the outpatient unit and one working in the wards. Additionally, the university hospital provided a special consultation hour in an oncological private practice close to patient's home. After completion of the project, 9 patients and the 2 "Caretakers" were interviewed via guided qualitative interviews. The main benefits for the patients were intensive support, avoiding long journeys and the close contact between hospital and private practice. The project had a clear positive effect on the patients' quality of life.

Use of symptom-focused oncological cancer therapies in hospices: a retrospective analysis.

BACKGROUND: There is controversy regarding the practical implementation of symptom-focused oncological cancer therapies to hospice residents. In this study, we aim to analyse the use and indication of supportive-oncological cancer therapies in hospices. METHODS: We conducted a retrospective survey of all residents of two hospice centres in the government district of Lower Bavaria, Germany. Hospice 1 (H1) was a member of an oncological-palliative medical network, and hospice 2 (H2) was independently organized. The evaluation period was the first 40 months after the opening of the respective hospice care centre. Demographical and epidemiological data as well as indications and type of supportive-oncological cancer therapies were recorded. A descriptive analysis and statistical tests were performed. RESULTS: Of the 706 residents, 645 had an underlying malignant disease. The average age was 72 years and the mean residence time was 28 days. The most frequent cancer types were gastrointestinal cancers, gynaecological cancers and bronchial carcinomas. Overall 39 residents (33 in H1 and 6 in H2, p < 0.01) received symptom-focused oncological cancer therapy. The average age of these residents was 68 years, and the mean residence time was 55 days. The most common therapeutic indications were dyspnoea and pain. The most common symptom-focused oncological cancer therapies were bisphosphonates, transfusions (erythrocyte- and platelet- concentrates), radiotherapy and anti-proliferative drugs (chemotherapy, anti-hormonal- and targeted- therapies). Patients with therapy lived significantly longer than patients without therapy (p < 0.01). CONCLUSIONS: Symptom-focused oncological cancer therapies can be implemented in hospices; however, their implementation seems to require certain structural and organizational prerequisites as well as careful patient selection. As a palliative medical approach, the focus is to ameliorate the symptoms and not prolong life. Symptom-focused oncology treatment could be a further and important part for the therapy of hospice patients in the future.

Social support networks and life cycle stage of Venezuelan immigrant families.

OBJECTIVE: To understand the structures of social networks of interiorized Venezuelan immigrant families and the life cycle stage they are in. METHODS: Qualitative multiple-case study with families from the Interiorization Program residing in the Greater Florianópolis, Brazil. Screening occurred through social networks and key informants. For data collection, the photovoice technique and semi-structured interviews were used, categorized with the help of the Atlas.ti software. Genograms and ecomaps were elaborated. RESULTS: Of the 4 families interviewed, totaling 7 members with young children, the nuclear family was identified as the main informal support network. Formal networks included schools, churches, and civil society. CONCLUSION: Families rely heavily on their nuclear structure for support, with formal institutions acting as secondary resources. The predominant life cycle stage is focused on families with young children. More efforts are needed to strengthen formal support networks.

Inpatient Hospices in Germany: Medical Care Situation and Use of Supportive Oncological Therapies for Symptom Control in Tumor Patients.

Background: More than 80% of the residents in German hospices suffer from tumor disease. But the administration of supportive-oncological therapies in hospices for symptom control is controversially discussed. Objectives: This study aims to investigate the care situation of tumor patients in German hospices with regard to medical care and the use of supportive-oncological therapies. Methods: In February 2019, all hospices in Germany were offered the opportunity to participate in an anonymous online survey on medical and drug care for their tumor patients. The survey was conducted using the online platform SoSci Survey and ended in April 2019. The analysis was descriptive. Results: Of 202 hospices, 112 responded to the questionnaire. The hospices were distributed nationwide. Most have 8 to 10 places. More than 80% of hospice residents are tumor patients, and the length of stay is usually three to four weeks. Medical care is primarily provided by primary care physicians. While specialized outpatient palliative care is increasingly involved in care, hematologists/oncologists are rarely represented. Supportive-oncological therapies are rarely prescribed, whereas medication for other chronic conditions is often continued. The percentage of supportive-oncological therapies prescribed is higher in hospices with oncology co-care. Conclusions: Although most hospice residents suffer from malignant disease, co-care by a hematologist/oncologist is rare. Supportive-oncology therapies, particularly for symptom relief, may therefore be rarely used. However, since a small select group of hospice residents may benefit from these therapies, further investigation in this direction should be undertaken.

Consequences of the Corona crisis on outpatient oncological care - a qualitative study among nurses and medical assistants.

INTRODUCTION: The Covid-19 pandemic has caused great personal stress for medical staff. To ensure adequate outpatient care for cancer patients, extensive safety and hygiene measures must be taken. This interview-based study examines the effects-both personal and professional-of the pandemic on the work routine of outpatient hematology/oncology nurses and medical assistants. PATIENTS, MATERIALS AND METHODS: Half a year after the outbreak of Covid-19 and the introduction of infection control regulations in three outpatient hematological/oncological centers, the affected medical staff (n = 15) were surveyed about the consequences for patient care and clinical work using audio-recorded telephone interviews. The interviews were transcribed and analyzed using a qualitative content analysis. RESULTS: The Covid-19 pandemic has complicated the medical care of cancer patients, but only a slight deterioration of medical and psycho-oncological care was observed. The level of stress experienced by medical staff is moderate, with hygiene and safety measures at the workplace helping to reduce stress. CONCLUSION: From the point of view of medical staff, the Covid-19 pandemic has had a moderate impact on the outpatient care of cancer patients. Safety measures against Covid-19 are decisive for ensuring the continuation of therapy and for motivating employees.

The tumor patient in the COVID-19 pandemic-an interview-based study of 30 patients undergoing systemic antiproliferative therapy.

INTRODUCTION: Five months after COVID-19 first occurred and protective regulations were introduced, patients at three outpatient hematological/oncological centers in Bavaria who had received antiproliferative tumor therapy (n = 30) were questioned about the pandemic's impact. PATIENTS, MATERIALS AND METHODS: In recorded semi-structured telephone interviews, the patients answered questions about their quality of life, treatment procedures, their relationship with medical care staff and modern communication technologies. Each interview consisted of 28 questions. The average length of an interview was 30 minutes. The interviews were transcribed and analyzed by means of a qualitative content analysis according to Mayring. RESULTS: The COVID-19 pandemic adds to the burden of patients by decreasing their social contacts. They perceived the new isolation and protective measures in outpatient clinics as mostly positive and said its impact had been only slightly adverse. With the implemented safety measures, they feel adequately protected and looked after and want their antiproliferative therapy to be performed as scheduled. Talking to medical staff provides additional reassurance. CONCLUSION: Although the COVID-19 pandemic has exacerbated the social isolation of tumor patients, it has had only a minor effect on tumor therapy in the surveyed patient population. The benefits of modern communication options to tumor patients remains uncertain and should be investigated further in future studies.

[A survey among family doctors on care reality of patients under oral tyrosine kinase inhibitor therapies]. / Befragung von Hausärzt*innen zur Versorgung von Patienten unter oralen Tyrosinkinaseinhibitoren.

INTRODUCTION: Oral tyrosine kinase inhibitor (TKI) therapies are becoming increasingly more important in the treatment of malignant diseases. Monitoring with focus on adherence, side effects and interactions poses new challenges for medical care. The role and capabilities of family doctors in the care of TKI patients are yet unclear and should be uncovered in a nationwide survey. METHODS: From April to July 2016, 3,000 family doctors in Germany were asked to complete a written questionnaire regarding their capabilities for co-supervision of TKI patients. RESULTS: The response rate was 18% (n=553). The peak age was between 50 and 60 years. 81% were specialists in general medicine, 14% specialists in internal medicine and 5% general practitioners. 98% cared for no or less than 10 TKI patients per quarter. Knowledge of side effects and interaction potential of TKIs was low in over 90%. 83% preferred monitoring by the treating oncologist and 93% felt uncertain about treatment monitoring. The control of adherence was of little importance in 66%. The number of treated TKI patients had a significant impact on knowledge and opportunities for treatment monitoring. There was a significant correlation between knowledge about TKIs and confidence in treatment monitoring. In general, younger doctors tended to be more confident in treatment monitoring, and specialists in internal medicine tended to have more knowledge than specialists in general medicine general practitioners and general practitioners. DISCUSSION: Currently, the low number of TKI patients, little knowledge about TKI, and the desire for specialist care are limiting the possibilities of co-caring for TKI patients by family doctors. CONCLUSION: Although family doctors are generally motivated to care for tumor patients, routine treatment controls of TKI patients conducted by family doctors seem hardly possible at the moment and should currently remain with the specialist.

Índices antropométricos e fatores associados entre crianças de uma unidade de saúde em município de grande porte do Paraná / Anthropometric indices and associated factors among children of a Health Unit in large city of Paraná

Estudo transversal objetivou estimar associações de características sociodemográficas e perfil de saúde com índices antropométricos ­ peso/idade, peso/estatura e estatura/idade ­ em crianças menores de dois anos usuárias de Unidade Estratégia Saúde da Família. Entrevistados responsáveis por crianças, por meio de amostragem de conveniência. Informações de 105 crianças, 58,1% sexo feminino. As prevalências de déficit de estatura e peso foram de 6,7% e 2,9%, e de excesso de peso, 10,5%. Maiores médias do índice peso/idade observadas para as crianças: com mães com menor escolaridade, maiores de seis meses, que não usavam chupeta e com diarreia. Para estatura/idade: ausência de mamada na primeira hora de vida e diarreia. Crianças menores de 6 meses em aleitamento materno exclusivo apresentaram maiores médias para peso/idade e estatura/ idade. Necessária cautela na interpretação dos resultados, importante acompanhar índices antropométricos para investigar mudanças no desenvolvimento infantil.

Cross-sectional study aimed to estimate associations of sociodemographic characteristics and health profile with anthropometric indices (weight/age, weight/ height, and height/age) in children under two years-oldwho are users of the Family Health Strategy Unit. The interviewees were responsible for the childrenand the interview was done through convenience sampling. Information from 105 children, 58.1% female. The prevalence of stunting and weight deficit was 6.7% and 2.9%, and overweight, 10.5%. Higher averages of the weight/age index observed for children: with mothers with lower levels of academic education, older than six months, who did not use a pacifier and with diarrhea. For height/age: no breastfeeding in the first hour of life, and diarrhea. Children under 6 months of exclusive breastfeeding classified the highest averages for weight/age and height/age. Caution is needed in the interpretation of results, it is important to monitorthe anthropometric indices to investigate changes in child development.

Promoção da saúde no contexto da tecnossocialidade: revisão integrativa da literatura / Health promotion in the context of technosociality: integrative literature review / Promoción de la salud en el contexto de la tecnosocialidad: una revisión integradora de la literatura

Na contemporaneidade, o uso de tecnologias pode se configurar como empecilho ou potência para a promoção da saúde. Este estudo tem como objetivo conhecer o que tem sido publicado sobre as redes sociais no quotidiano das pessoas no processo de saúde e adoecimento para a promoção da saúde. Materiais e Métodos: Revisão integrativa de literatura em cinco bases de dados, no recorte histórico de 2015 a 2019. Resultados: 12 artigos foram analisados, resultando em três categorias: 'Tecnossocialidade: Rede Social no engajamento terapêutico'; 'Tecnossocialidade: Rede Social como ferramenta de empoderamento'; 'Tecnossocialidade: A produção de conhecimento'. Discussão: Destaca-se a necessidade de avaliação para validação das informações socializadas, e debate sobre a efetividade da aplicação prática dos conhecimentos adquiridos pelo usuário. Conclusões: O enfoque do empoderamento em debate nas redes sociais volta-se majoritariamente para a perspectiva individual, ficando aquém do incentivo à participação comunitária sugerida na Política Nacional de Promoção da Saúde.(AU)

Introduction: In the contemporary world, the use of technologies can be configured as an obstacle or incentive for health promotion. This study aims to find out what has been published about social networks in people's daily lives in the health and illness process for health promotion. Materials and Methods: Integrative literature review in five databases, in the historical section from 2015 to 2019. Results: 12 articles were analyzed, resulting in three categories: 'Technosociality: Social Network in therapeutic engagement'; 'Technosociality: Social Network as an empowerment tool'; 'Technosociality: The production of knowledge. Discussion: The need for evaluation to validate socialized information is highlighted, and a debate on the effectiveness of the practical application of the knowledge acquired by the user. Conclusions: The focus on empowerment in the debate on social networks is mostly focused on the individual perspective, falling short of encouraging community participation suggested in the National Health Promotion Policy.(AU)

Introducción: En el mundo contemporáneo, el uso de tecnologías se puede configurar como obstáculo o poder para la promoción de la salud. Este estudio tiene como objetivo conocer qué se ha publicado sobre las redes sociales en la vida cotidiana de las personas en el proceso de salud y enfermedad para la promoción de la salud. Materiales y Métodos: Revisión bibliográfica integradora en cinco bases de datos, en la sección histórica de 2015 a 2019. Resultados: Se analizaron 12 artículos, resultando en tres categorías: 'Tecnosocialidad: Red social en el compromiso terapéutico'; "Tecnosocialidad: las redes sociales como herramienta de empoderamiento"; "Tecnosocialidad: la producción de conocimiento". Discusión: Es necesaria la evaluación para validar la información socializada, y debatir la efectividad de la aplicación práctica de los conocimientos adquiridos por el usuario. Conclusiones: El enfoque en el empoderamiento en el debate en las redes sociales se centra mayoritariamente en la perspectiva individual, sin llegar a fomentar la participación comunitaria sugerida en la Política Nacional de Promoción de la Salud.(AU)

A teoria do desenvolvimento da família: buscando a convergência entre a teoria e a prática no cotidiano dos profissionais de saúde

A ênfase dada às questões de família atualmente requer dos profissionais de saúde a busca de referenciais teóricos que abordem a família em sua especificidade, a fim de subsidiar suas atividades profissionais. Este estudo tem por objetivos: descrever as principais características da teoria do desenvolvimento da família, realizando um exercício de sua aplicabilidade a situações vivenciadas pelas autoras em seus cotidianos com famílias nos serviços de saúde e identificar as possibilidades e os desafios de se convergir teoria e prática no campo da saúde. O referencial utilizado é a Teoria do desenvolvimento da Família. Trata-se de uma reflexão teórica da qual as autoras descrevem as principais características, os pressupostos e os conceitos desse objeto de estudo. Num exercício teórico-prático, as autoras voltam-se para sua prática cotidiana, buscando a convergência entre o que é preconizado pela teoria e pela prática profissional. Foram identificados como aspectos positivos da teoria os conceitos de família, a crise maturacional e situacional, a idéia de carreira familiar, entre outros. Dentre os vazios, verificou-se a ausência do conceito saúde-doença e a falta de maiores subsídios para as crises maturacionais. Como desafio para a expansão da teoria, é sugerido o aprofundamento das discussões dos conceitos inexistentes ou pouco desenvolvidos. Além disso, as autoras propõem a aplicação da teoria em diferentes situações nos serviços de saúde, com o objetivo de testar sua adequação no atendimento às famílias. (AU)