[Patient education for self-management of oral anticoagulation - situation in Hesse]. / Patientenschulungen zum Gerinnungsselbst-management - Angebotssituation in Hessen.

AIM: Oral anticoagulation (OAC) has been shown to be highly effective in preventing thromboembolic complications. Self-management can enable patients with a long-term indication for OAC to be actively involved in the therapy, but in Germany the implementation of self-management is linked to mandatory training. To illustrate significant structural disparities between education centres in Hesse, all such centres were identified and a list generated, specifying the differences. METHOD: Using our own questionnaire, we interviewed all known patient education centres in Hesse between January and July 2012, and conducted a descriptive analysis of their structural features. RESULTS: There were 44 datasets for statistical interpretation. We distinguished between centres with ASA certification (n=19) and centres without (n=25). On average, certified centres provide 6 h of training (range 2-9) compared to 5.5 h (range 1-12) in uncertified centers. Certified centres hold more group sessions per year (on average 17 vs. 8) and more individual training sessions (on average 10 vs. 5). Certified centres train 10-365 patients per year and uncertified centers between 5 and 77. Certified centres offer retraining more frequently (84% vs. 40%) and more often conclude the training with a written test (74% vs. 44%). Only 9 centres provide materials for patients with a migration background. CONCLUSION: The results show that in Hesse, severe structural discrepancies exist in training programmes for self-management of OAC, and it can be assumed that patients participating in trainings in different Hessian education centres face very differing conditions. To improve the quality of the trainings and to ensure patients have similar levels of knowledge, it is imperative that centres be regularly inspected with the help of proven quality indicators.

Practice-based depression case management in primary care: a qualitative study on family doctors' perspectives.

BACKGROUND: Case management provided by health care assistants (HCAs) is effective in improving primary care for depressive patients. Little is known on the implementation-related aspects of case management performed in small family practices. OBJECTIVE: To explore family doctors' perspectives on clinical and organizational aspects of implementation of case management and perceived practice-related aspects associated with patient care after 1 year's experience of HCAs providing case management for depressive patients in their practices. METHODS: This qualitative study was nested in a cluster-randomized trial on case management provided by practice-based HCAs for patients with major depression in Germany. We used semi-structured interview guides and performed audio-taped interviews with family doctors. Full transcription and thematic content analysis were carried out. RESULTS: Twenty-three family doctors were interviewed. The family doctors perceived case management as beneficial to patients and reported that it improved their consultation styles and doctor-patient relationships. They implemented case management elements into their everyday day work using 'concrete', 'subsumed' or 'progressive' implementation styles. CONCLUSIONS: Family doctors perceived practice-based case management by HCAs as beneficial for patient care. Different implementation styles may be appropriate, depending on the health care setting, and this requires further evaluation.

The Patient Assessment of Chronic Illness Care questionnaire: evaluation in patients with mental disorders in primary care.

The Chronic Care Model provides evidence-based recommendations to improve the care for patients with chronic conditions. The Patient Assessment of Chronic Illness Care questionnaire (PACIC) is an instrument to evaluate the patient's perspective on receipt of care delivered in the five domains patient activation, delivery system, goal setting, problem solving, and follow-up. The aim of this study was to assess the psychometric characteristics of the PACIC in 442 primary care patients with major depression. The psychometric properties were good. We found possible ceiling effects in the two subscales 'patient activation' (12.9%) and 'problem solving/contextual' (8.9%), as well as floor effects in 'goal setting/tailoring' (4.6%). The Cronbach's α coefficient for the total scale was excellent (0.91). We found two major factors, which we labeled according to the PACIC domains as composite factors 'patient activation and problem solving' as well as 'goal setting and coordination'. The perspective of patients with mental disorders, such as depression, on primary chronic illness care can be assessed adequately by the PACIC.

Evaluation of field propagation of Muscidifurax zaraptor (Hymenoptera: Pteromalidae) for control of flies associated with confined beef cattle.

The parasitic wasp Muscidifurax zaraptor Kogan & Legner was mass-reared in the field to control house flies, Musca domestica L., on two Nebraska beef cattle confinements. About 50,000 freeze-killed house fly pupae were exposed to a single release of M. zaraptor in the field. Placement of six additional cohorts of 50,000 freeze-killed pupae at the release sites at 2-wk intervals resulted in a mean parasite emergence of 56.4% over the study period. Mean fly mortality of 37.3 and 25.9% occurred in sentinel pupae placed around the perimeter of two release sites, compared with 3.9% for two control sites. We demonstrated a negative correlation between host reduction in sentinel cohorts and distances the cohorts were placed from parasite release sites. However, data indicated that other environmental factors also influenced the success of M. zaraptor in locating sentinel hosts. Correlation between mortality in sentinel pupae and numbers of parasites released was not evident. Temperatures above approximately 28 degrees C appeared to reduce the effectiveness of M. zaraptor.

Infectivity of Serratia marcescens (Eubacteriales: Enterobacteriaceae) in Stomoxys calcitrans (Diptera: Muscidae).

Serratia marcescens Bizio, a facultative pathogen of insects, was isolated from stable flies, Stomoxys calcitrans (L.), collected from Nebraska beef cattle feedlots and dairies. Infection rates in laboratory-reared stable flies infected by topical exposures to the bacterium were 57 and 64% in two experiments. Per os exposures to sucrose and water solutions, and bovine blood inoculated with S. marcescens, produced mortality rates of about 45 and 10%, respectively.

Effects of host age, host density and parent age on reproduction of the filth fly parasite Urolepis rufipes (Hymenoptera: Pteromalidae).

Urolepis rufipes Ashmead, a pteromalid wasp, was recently discovered parasitizing house fly and stable fly pupae in eastern Nebraska dairies. Studies have been conducted on the biology of this parasite to evaluate its potential as a biological control agent of stable flies (Stomoxys calcitrans (L.] and house flies (Musca domestica L.). House fly pupae were suitable as hosts for U.rufipes at all ages; however, significantly higher parasitism occurred on host pupae aged 96-120 h. Parasite-induced mortality (host mortality without progeny production) was higher than for other pteromalid parasites of filth flies under similar conditions. Parasitism increased with parasite--host ratio at 20 degrees C; however, the opposite was noted at 30 degrees C for parasite--host ratios ranging from 5:50 to 50:50. Fly eclosion decreased as parasite--host ratio increased at 20 degrees C, and no host eclosion occurred at the highest parasite--host ratios (20:50 and 50:50) at 30 degrees C. Females produced an average of 18.6 female and 7.6 male progeny. 88% of the progeny were produced during the first 6 days post parental eclosion. The short life span, low progeny emergence rate and high per cent host eclosion, in comparison with other parasite species, suggests that the Nebraska strain of U.rufipes may not an effective biological control agent of house flies.

Early season dispersal of Muscidifurax zaraptor (Hymenoptera: Pteromalidae) utilizing freeze-killed housefly pupae as hosts.

The pteromalid wasp, Muscidifurax zaraptor Kogan and Legner, was released at three locations at a dairy in May before housefly and stable fly breeding had begun. Freeze-killed housefly pupae were placed adjacent to the emerging parasites at biweekly intervals for a 6-week period. Hosts placed out weeks 0 and 2 were heavily parasitized. Decreased parasitism in hosts placed out at week 4 suggested that many of the M. zaraptor had dispersed or died. High parasitism of hosts placed in the field at week 6 was the result of second generation parasites emerging from pupae placed out at week 0. Parasitism of freeze-killed housefly pupae placed 6 m and in the four cardinal directions from the release points was similar but lower than for hosts placed adjacent to the emerging parasites. The study demonstrated that emerging M. zaraptor readily utilized nearby freeze-killed housefly pupae but the availability of these hosts did not deter the parasites from searching for additional hosts.

Susceptibility of Psorophora columbiae Larvae over Time to Parasitism by Romanomermis culicivorax.

The ability of Romanomermis culicivorax preparasites to penetrate and infect Psorophora columbiae decreased substantially after ca. 28 hours. Parasitism at temperatures typical of Louisiana rice fields (i.e., 26, 29, and 32 +/- 0.5 C) showed a significant linear decrease (P < 0.01) as the percentage of older larval instars increased at the times of exposure. These data emphasize the need for a synchronous field application of preparasites to challenge the rapid development of early instars of Ps. columbiae. Applications of postparasites rather than insecticide treatments to potential mosquito breeding habitats may offer greater flexibility in larval mosquito control programs.

An Improved Method for Long-Distance Shipping the Mosquito Parasite Romanomermis culicivorax.

To prevent losses during long-distance shipment, a new delivery system was developed for the mosquito parasite Romanomermis culicivorax. A specially designed shipping container, two types of culture media (sand and a mixture of sand, vermiculite, and charcoal [SVC]), and two types of insert (polystyrene and polyester urethane foam [PUF]) were tested. Cultures shipped in SVC/PUF insert combination produced significantly higher yields of preparasites than did the other three combinations tested, and the sand/polystyrene combination produced significantly lower yields than did either sand or SVC media shipped with the PUF insert. Yields from cultures shipped in sand/PUF and SVC/PUF combinations were significantly lower than from unshipped controls. Maximum losses (52%) occurred in cultures shipped when 13-16-wk old. Also, yields of preparasites were significantly lower from cultures shipped singly when compared to similar cultures shipped in groups of eight. Techniques and procedures developed in this study did not completely solve the loss associated with delivery of R. culicivorax. For the first time, however, the system can guarantee the delivery of a quality product. The study defines the importance of the carrier medium, age of cultures, shipment size, and the restriction of the movement of the culture medium.

Commercial development and future prospects for entomogenous nematodes.

Although entomogenous nenmtodes generally have many of the attributes of the ideal biocontrol agent, many of these attributes make the nematodes less than desirable for commercial production. Environmental limitations, lack of patent protection, "shelf life," shipping problems, and the need for users to receive specialized training are factors that have discouraged the involvement of larger companies. The future of these nematodes as commercially available biocontrol products appears to lie with the smaller "cottage industries" or with government-subsidized production. Problems encountered with attempts to produce commercially the mosquito parasite Romanomermis culicivorax are discussed.