"Qualitative evaluation of a digital software solution for documentation and training in 24-hour home care".

Owing to its cost-efficiency, 24-hour home care is increasing and represents a cornerstone in the care of elder people in Austria. A software solution to support 24-hour caregivers in their daily routine was developed facilitating a user-centered design process. It includes electronic documentation, an e-learning platform, emergency management, and a communication tool. To evaluate the usability and acceptance of the developed software solution, a qualitative survey including focus groups (FG), a group interview (GI), and a usability walkthrough (UW) were conducted. This paper describes the findings of the qualitative survey which indicate that the e-learning platform as well as the e-documentation support 24-hour caregivers in their daily work with their clients. Participants with less technical affinity needed support to use the tool proficiently. 24-hour caregivers appreciate the fact that the solution unites all the needed information in one place.

Digital support for quality assurance in 24-hour caregiving at home: a randomized controlled trial investigating the effects on quality of life and professional skills of paid 24h-caregivers.

BACKGROUND: Regarding the care of older adults, 24-h home-care represents a cornerstone, with > 32,000 service users in Austria. Our research project 24hQuAALity aimed to develop and evaluate a distributed client-server software solution for the support and quality assurance of this home-care service. In this trial, we investigated the effects of this intervention on the quality of life and professional skills of paid 24h-caregivers in Austria. METHODS: The application used in our study comprises an e-learning platform, an integrated emergency management, networking opportunities, and an electronic care documentation system in the native language of the 24h-caregivers. The trial was conducted using a parallel three-arm study design to evaluate (i) a control group, which performed usual home care, (ii) a partial intervention group, which used the e-learning and networking platforms, and (iii) a full intervention group, which used the entire intervention (e-learning platform, networking platform, and digital care documentation). Primary self-reported outcomes were the standardized ASCOT for Carers score and a score based on responses to project-specific efficacy questions. RESULTS: Among the 110 24h-caregivers who were randomly classified into the three groups, ASCOT for Carers score data were available for 57 and 35 24h-caregivers at 5- and 9-month follow-up examinations, respectively. At 9 months, 24h-caregivers receiving any intervention rated the ASCOT for Carers score (not significantly) better than the controls (p = 0.05, ηp2 = 0.15), mainly in the domain "feeling encouraged and supported". At 9 months, 24h-caregivers receiving any intervention rated the project-specific Efficacy score significantly better than the controls (p = 0.02, ηp2 = 0.20), mainly due to better ratings in the subitems "satisfaction with current docu", "docu supports doing my job", " I'm well prepared for emergencies", "my professional skills are adequate for doing my job", and "communication with contacts". CONCLUSIONS: Providing e-learning and e-documentation devices to 24h-caregivers improved their care-related quality of life, mainly because they felt more encouraged and supported. Moreover, these interventions improved their self-perceived professional skills. As an extrapolation of findings, we found that these interventions could empower 24h-caregivers and improve the quality of home-care services provided by them. TRIAL REGISTRATION: Digital Support for Quality Assurance in 24-h Caregiving at Home was registered and posted on the ClinicalTrials.gov public website (ClinicalTrials.gov Identifier: NCT04581538).

Single-cell profiling and zebrafish avatars reveal LGALS1 as immunomodulating target in glioblastoma.

Glioblastoma (GBM) remains the most malignant primary brain tumor, with a median survival rarely exceeding 2 years. Tumor heterogeneity and an immunosuppressive microenvironment are key factors contributing to the poor response rates of current therapeutic approaches. GBM-associated macrophages (GAMs) often exhibit immunosuppressive features that promote tumor progression. However, their dynamic interactions with GBM tumor cells remain poorly understood. Here, we used patient-derived GBM stem cell cultures and combined single-cell RNA sequencing of GAM-GBM co-cultures and real-time in vivo monitoring of GAM-GBM interactions in orthotopic zebrafish xenograft models to provide insight into the cellular, molecular, and spatial heterogeneity. Our analyses revealed substantial heterogeneity across GBM patients in GBM-induced GAM polarization and the ability to attract and activate GAMs-features that correlated with patient survival. Differential gene expression analysis, immunohistochemistry on original tumor samples, and knock-out experiments in zebrafish subsequently identified LGALS1 as a primary regulator of immunosuppression. Overall, our work highlights that GAM-GBM interactions can be studied in a clinically relevant way using co-cultures and avatar models, while offering new opportunities to identify promising immune-modulating targets.

Tyrosine-protein kinase Yes controls endothelial junctional plasticity and barrier integrity by regulating VE-cadherin phosphorylation and endocytosis.

Vascular endothelial (VE)-cadherin in endothelial adherens junctions is an essential component of the vascular barrier, critical for tissue homeostasis and implicated in diseases such as cancer and retinopathies. Inhibitors of Src cytoplasmic tyrosine kinase have been applied to suppress VE-cadherin tyrosine phosphorylation and prevent excessive leakage, edema and high interstitial pressure. Here we show that the Src-related Yes tyrosine kinase, rather than Src, is localized at endothelial cell (EC) junctions where it becomes activated in a flow-dependent manner. EC-specific Yes1 deletion suppresses VE-cadherin phosphorylation and arrests VE-cadherin at EC junctions. This is accompanied by loss of EC collective migration and exaggerated agonist-induced macromolecular leakage. Overexpression of Yes1 causes ectopic VE-cadherin phosphorylation, while vascular leakage is unaffected. In contrast, in EC-specific Src-deficiency, VE-cadherin internalization is maintained, and leakage is suppressed. In conclusion, Yes-mediated phosphorylation regulates constitutive VE-cadherin turnover, thereby maintaining endothelial junction plasticity and vascular integrity.

A backward-mode optical-resolution photoacoustic microscope for 3D imaging using a planar Fabry-Pérot sensor.

Optical-resolution photoacoustic microscopy (OR-PAM) combines high spatial resolution and strong absorption-based contrast in tissue, which has enabled structural and spectroscopic imaging of endogenous chromophores, primarily hemoglobin. Conventional piezoelectric ultrasound transducers are typically placed far away from the photoacoustic source due to their opacity, which reduces acoustic sensitivity. Optical ultrasound sensors are an alternative as their transparency allows them to be positioned close to the sample with minimal source-detector distances. In this work, a backward-mode OR-PAM system based on a planar Fabry-Pérot ultrasound sensor and coaxially aligned excitation and interrogation beams was developed. Two 3D imaging modes, using raster-scanning for enhanced image quality and continuous-scanning for fast imaging, were implemented and tested on a leaf skeleton phantom. In fast imaging mode, a scan-rate of 100,000 A-lines/s was achieved. 3D images of a zebrafish embryo were acquired in vivo in raster-scanning mode. The transparency of the FP sensor in the visible and near-infrared wavelength region makes it suitable for combined functional and molecular imaging applications using OR-PAM and multi-photon fluorescence microscopy.

The lived experience of adolescent users of mental health services in Vienna, Austria: A qualitative study of personal recovery.

PROBLEM: In Austria, one in four adolescents suffers from a mental health problem, yet there is a lack of adequate care structures. Therefore, the personal recovery of these adolescents is of particular interest. The aim of the study was to explore, from a Child and Adolescent Psychiatric Mental Health Nursing (CAPMHN) perspective, how adolescent users of mental health services in Vienna, Austria experienced personal recovery after a stay in hospital, and to discover what had influenced the personal recovery of adolescent users of mental health services in Vienna. METHODS: Ten episodic interviews with adolescents were conducted. Nine of them were analyzed following the content analysis of Mayring (2015). FINDINGS: The findings of the survey indicate that the personal recovery of the participants was influenced by personal and external factors. Personal factors were the subjective experience of illness and recovery, optimism, resources, and ambivalence. External factors were family, peers, and treatment. The findings suggest that personal recovery of adolescents with a mental health problem is affected by youth-specific aspects. CONCLUSIONS: CAPMHNs can support the personal recovery of adolescent users of mental health services, so providing recovery-oriented care, adequate care structures, and specific nursing skills is crucial.

[Quality characteristics in 24-hour care from the perspective of those affected - Results of a pilot study in Austria]. / Qualitätsmerkmale in der 24 h-Betreuung aus der Perspektive der Betroffenen - Ergebnisse einer Pilotbefragungsstudie in Österreich.

Quality characteristics in 24-hour care from the perspective of those affected. Results of a pilot study in Austria Abstract. Background: Of the almost 460 000 recipients of care allowance in Austria, 80 % are cared for at home. In 2018, more than 32 000 people were cared for at home by a total of almost 65 000 24-hour caregivers. Isolated work situations in combination with complex illnesses of the clients, often inadequate training and a lack of language skills of the personal carers have a challenging effect on the quality of care. Aim: The aim of the pilot study is to describe quality characteristics in 24-hour personal care from the perspective of the actors involved. The research question relates firstly to the individual experience and secondly to the desired quality of care. Methods: The survey method used is an individual survey along a guideline; the summarising content analysis has been chosen as the evaluation method. Results: A total of 32 interviews were conducted (14 relatives, 1 client, 8 caregivers and 9 DGKP). In the analysis process, it was possible to map all the aspects mentioned using the developed main category "field of action-oriented quality characteristics". These relate to comprehensive everyday care, specialist nursing and medical activities, individual care, language skills and communication, as well as initial and continuing training and interface management. Conclusions: The development of binding quality criteria together with continuous external support is essential to ensure sustainable quality of care. This could be taken over by the established social associations.

Quantitation of Six Alternaria Toxins in Infant Foods Applying Stable Isotope Labeled Standards.

Alternaria fungi are widely distributed saprophytes and plant pathogens. As pathogens, Alternaria fungi infect crops and vegetables and cause losses in the fields and during postharvest storage. While farmers suffer from declining yields, consumers are endangered by the formation of secondary metabolites, because some of these exhibit a pronounced toxicological potential. The evaluation of the toxicological capabilities is still ongoing and will contribute to a valid risk assessment. Additionally, data on the incidence and the quantity of Alternaria mycotoxins found in food products is necessary for dietary exposure evaluations. A sensitive LC-MS/MS method for the determination of the Alternaria mycotoxins alternariol (AOH), alternariol monomethylether (AME), tentoxin (TEN), altertoxin I (ATX I), alterperylenol (ALTP), and tenuazonic acid (TA) was developed. AOH, AME, and TA were quantified using stable-isotopically labeled standards. TEN, ATX I, and ALTP were determined using matrix matched calibration. The developed method was validated by using starch and fresh tomato matrix and resulted in limits of detection ranging from 0.05 to 1.25 µg/kg for starch (as a model for cereals) and from 0.01 to 1.36 µg/kg for fresh tomatoes. Limits of quantification were determined between 0.16 and 4.13 µg/kg for starch and between 0.02 and 5.56 µg/kg for tomatoes. Recoveries varied between 83 and 108% for starch and between 95 and 111% for tomatoes. Intra-day precisions were below 4% and inter-day precisions varied from 3 to 8% in both matrices. Various cereal based infant foods, jars containing vegetables and fruits as well as tomato products for infants were analyzed for Alternaria mycotoxin contamination (n = 25). TA was the most frequently determined mycotoxin and was detected in much higher contents than the other toxins. AME and TEN were quantified in many samples, but in low concentrations, whereas AOH, ATX I, and ALTP were determined rarely, among which AOH had higher concentration. Some infant food products were highly contaminated with Alternaria mycotoxins and the consumption of these individual products might pose a risk to the health of infants. However, when the mean or median is considered, no toxicological risk was obvious.

[Influence and correlation of attitude, availability and institutional support to research implementation in nursing practice ­ results from an exploratory, cross-sectional quantitative study]. / Einfluss und Zusammenhang von Einstellung, Verfügbarkeit und institutioneller Unterstützung auf die Anwendung von Forschungsergebnissen in der pflegerischen Praxis - Ergebnisse einer explorativen quantitativen Querschnittstudie.

BACKGROUND: The concrete application of research findings in nursing practice is a multidimensional process. In Austria, there are currently no results available that explain the impact of and association with the implementation of research in hospitals. OBJECTIVE: The aim of the study was to investigate influences and relationships of individual attitudes towards research utilization, availability of research results and institutional support of nurses in Austrian hospitals with respect to research application. METHODS: In a non-experimental quantitative cross-sectional design a multi-centre study (n = 10) was performed in 2011. RESULTS: The sample comprises 178 certified nurses who were interviewed with a survey questionnaire. The multiple regression analysis shows that a positive attitude towards research use (ß = 0.388, p < 0.001), the availability of processed research results (ß = 0.470, p < 0.001), and an adequate institutional support (ß = 0.142, p < 0.050) has a significant influence on the application of research results. The path analysis proves that course attendance in evidence-based nursing has a strong positive influence towards research application (ß = 0.464; p < 0.001). CONCLUSIONS: Health institutions are, according to legal instructions, called on to make use of the positive attitude and supply supporting measures in order to introduce research results into the daily nursing practice.

Validity and reliability of the "German Utilization Questionnaire-Dissemination and Use of Research" to measure attitude, availability, and support toward implementation of research in nursing practice.

BACKGROUND AND PURPOSE: In nursing practice, research results have to undergo a systematic process of transformation. Currently in Austria, there is no empirical data available concerning the actual implementation of research results. An English validated questionnaire was translated into German and tested for validity and reliability. METHOD: A survey of 178 registered nurses (n = 178) was conducted in a multicenter, quantitative, cross-sectional study in Austria in 2011. RESULTS: Cronbach's alpha values (.82-.92) were calculated for 4 variables ("use," "attitude," "availability," "support") after the reduction of 7 irrelevant items. Exploratory factor analysis was calculated with Kaiser-Meyer-Olkin (KMO) ranging from .78 to .92; the total variance ranged from 46% to 56%. CONCLUSION: A validated German questionnaire concerning the implementation of research results is now available for the nursing practice.

[Evaluation of the nursing diagnosis "social isolation" and the use of evidence-based nursing]. / Evaluierung von Interventionen aufgrund der Pflegediagnose "Soziale Isolation" und Anwendung der Methode Evidence-based Nursing.

In home nursing care, professionally qualified personnel have to make many decisions based on the best available evidence. The systematic review "social isolation" was carried out to evaluate the nursing diagnosis as used by the home care provider Red Cross Austria. It was examined if the interventions of the diagnosis "social isolation" were based on scientific evidence. The interventions reviewed were exclusively for home care clients. "Evidence Based Nursing" was used as the scientific approach. Individual interventions of the selected diagnosis's were compared to the Nursing Interventions Classification (NIC) to get standardized English search terms. The 10 selected research papers showed that social isolation is a growing problem for people being cared for at home. According to the scientific literature it can be recommended that a number of multi variant initiatives should be initiated either as a prophylactic or specific intervention. The use of appropriate assessment instruments should lead to effective interventions. Furthermore, in cases of particular need a tailor-made group solution can be helpful. One new aspect that surfaces in the literature is the social isolation of the relatives of the person in care. The social isolation of the relatives in turn has a strong influence on the person in care and nursing care personnel should include this in the intervention plan. Home care nursing personnel play a key role in identifying social isolation and taking the first initiatives to resolve the problem.

[Diagnosis "risk of pneumonia" evidence-based evaluation and comparison of nursing interventions]. / Pflegediagnose "Gefahr einer Pneumonie". Evaluierung und Vergleich evidenzbasierter und pflegepraktischer Interventionen.

In home nursing care, professionally qualified nurses make decisions on their own which must be based on the latest scientific research. The goal of this systematic literature review was to examine if the interventions of the diagnosis "Risk of Pneumonia" as used by a home care service provider in Austria are based on scientific evidence. Based on the research question "Can the interventions of the diagnosis 'risk of pneumonia' be found in the scientific nursing literature?", four evidence-based guidelines from various databases and institutes were identified and evaluated using a standardized checklist. The result of the analysis is that the majority of the Nursing diagnosis interventions can be found in the guidelines. It is also recommended in the guidelines to advise and support clients to stop smoking and inoculate against influenza/pneumonia. Similarly, assessment tools should be used to estimate the severity of pneumonia. The intervention of oral hygiene as a prophylactic intervention against pneumonia should get particular attention.