"Care for the Common Home": Responses to Pope Francis's Encyclical Letter.

This article aims to build awareness of the growing global crisis in social, economic and environmental terms from different disciplinary approaches. The authors respond to the message of Pope Francis presented in his Encyclical Letter published in 2015. The article provides a short current overview of the discourse and presents three hypotheses anchored in the disciplines of Psychology, Health and Theology for a deeper discussion of Pope Francis's viewpoints on the challenges to humankind and how to address them. It thereby contributes to the discourse on health and religion with regard to the Pope's message to the world community. The article leads to an interdisciplinary conclusion and directions for future research and practice.

[Place of death nursing home]. / Sterbeort stationäre Pflegeeinrichtung.

BACKGROUND: There are no empiric results concerning the quality of care for dying persons at nursing homes up to now. 30-40% of all Germans pass away at nursing homes. This study was carried out in 2014 and is presented now. It's aim is to describe the nursing, medical and psychosocial situation and - if necessary - to word suggestions for improvement. METHOD: A total of 2,080 questionnaires from employees of 467 nursing homes could be evaluated. By choosing the nursing homes, federal state, size and location as well as their sponsorship were considered. A proven questionnaire was slightly adapted for this usage. The questionnaire containes 11 institution-related and personal variables as well as 33 variables with regards to content. RESULTS: One third of the interviewees describe a lack of time and personnel resources. Only 34% state that qualified nurses take care of the dying persons. 53% indicate that there is a cooperation with complementary care partners. 38% feel well- or very well-prepared by education, 31% feel ill-prepared for nursing dying persons. 44% attest that they have the possibility to insert influence on the situation. 75% indicate that there is a dialogue with collegues when a resident has died. In 6 of 10 nursing homes family members are allowed to stay overnight. Family members are bindingly involved in the care of the dying persons to 33%. 27% of the interviewees state that volunteers regularly assist their nursing home. 75% state that there is a successful pain- and symptom control. 30% indicate that there are no needlessly life prolonging interventions. Just as many describe life prolonging interventions as a norm. Only 35% state that the patients are generally told about their prognosis. 35% of the interviewees state that the patients generally pass away all alone, nevertheless 75% of the interviewees are sure that in their workplace it is possible to pass away in dignity. It could be shown that conditions are more problematic in big, urban and private nursing homes. RECOMMENDATIONS: The arising recommendations have turned out little effective up to now. Hence, the author recommends that the process of caring for dying persons should be checked by an independent quality testing association. Nursing homes which dispose of good and very good care processes should be marked by a "German palliative seal".

[The G-BA innovation fund's project "Avenue-Pal" - analysis and improvement of cross-sectoral and cross-departmental interface and relocation management in palliative care]. / Das G-BA-Innovationsfonds-Projekt "Avenue-Pal" : Analyse und Verbesserung des sektor- und bereichsübergreifenden Schnittstellen- und Verlegungsmanagements in der Palliativversorgung.

BACKGROUND: About 80% of all people in Germany die in inpatient care. Around every fifth person in inpatient care is relocated to another care area in the last phase of their life. That is more than 150,000 people being relocated, often without indication. 13 risk factors were identified for these non-indicated relocations. METHOD: With the support of the AWMF, two regionally effective guidelines were developed and implemented in a maximum care hospital and a care facility. A palliative consultation service has been established in the university hospital. Comprehensive personnel and organizational development was carried out in the care facility. Different collaborations with relevant regional partners of both model institutions were systematically expanded. RESULTS AND CONCLUSIONS: The relocations could be significantly reduced despite the short duration of the project. This was also possible through the establishment of decision-making aids and digital implementation support. The results of the accompanying ethical and social research justify the procedure: There is an increase in the satisfaction of relatives and employees.

[Improving the care of dying persons taking center of a G-BA innovation fund's project]. / Verbesserung der Versorgung Sterbender im Mittelpunkt eines G-BA-Innovationsfonds-Projektes.

Nursing home residents and hospital patients are often relocated to other facilities or within their own facility in their last days of life. This means an additional burden for those affected and their relatives. In the Avenue-Pal project, the current transfer practice of dying persons is to be recorded and analyzed. Based on this data, care guidelines for hospitals and nursing homes are to be developed. The aims are to reduce the frequency of relocation, to increase the quality of care, to improve the satisfaction of those affected and their families, but also of the nursing staff, and last but not least, to save resources. The project is funded by the Innovation Fund of the Federal Joint Committee (G-BA).

[Empirical findings concerning transfer of dying persons]. / Empirische Befunde zur Verlegungspraxis Sterbender.

BACKGROUND: Own studies from the years 2013 and 2014 had shown that patients in hospital or inhabitants of nursing home get transferred even in their last, terminal phase of life. METHOD: In order to describe such transfers, a 27-item questionnaire was developed in 2016. This was addressed to employees from hospitals and nursing homes. The questionnaire determines the frequency of the laying (a), preferred periods (b), location (c) and influencing factors (d). 101 hospitals and 65 nursing homes of different sizes, carriers and federal states were included. RESULTS: In about 20% of the cases in the hospitals and in about 25% of the cases in nursing homes, dying patients are transferred. This would account for a total of approximately 150,000 patients or residents. Nursing homes place dying patients in hospitals. In the hospitals the relocations take place within the facility. No preferences of weekday or daytime could be identified. Acute physical deterioration of the state is identified as the central cause of displacement. In contrast, mental-psychological reasons are less significant. If relatives and other care partners are well involved, fewer relocations occur. Written patient agreements have a medium to distinct influence. Continuously insufficient staff has a stronger impact than an acute lack of personnel. RECOMMENDATIONS: Physiological deterioration of the dying person must not result in an alarm and associated solution chain. A special risk management or case management for this group could prevent misallocation. The "Advance Care Planing" passed by the Hospiz- and Pallitativgesetz in 2015 should also reduce the relocation frequency.

The Clinical Significance of HbA1c in Operable Chronic Thromboembolic Pulmonary Hypertension.

BACKGROUND: Glycosylated hemoglobin A1c (HbA1c) has been proposed as an independent predictor of long-term prognosis in pulmonary arterial hypertension. However, the clinical relevance of HbA1c in patients with operable chronic thromboembolic pulmonary hypertension (CTEPH) remains unknown. The aim of the present study was to investigate the clinical significance of HbA1c as a biomarker in CTEPH. METHODS: Prospectively, 102 patients underwent pulmonary endarterectomy (PEA) in our national referral center between March 2013 and March 2014, of which after exclusion 45 patients were analyzed. HbA1c- levels, hemodynamic and exercise parameters were analyzed prior and one-year post-PEA. RESULTS: 45 patients (BMI: 27.3 ± 6.0 kg/m2; age: 62.7 ± 12.3 years) with a mean pulmonary arterial pressure (mPAP) of 43.6 ± 9.4 mmHg, a pulmonary vascular resistance (PVR) of 712.1 ± 520.4 dyn*s/cm5, a cardiac index (CI) of 2.4 ± 0.5 l/min/m2 and a mean HbA1c-level of 39.8 ± 5.6 mmol/mol were included. One-year post-PEA pulmonary hemodynamic and functional status significantly improved in our cohort. Baseline HbA1c-levels were significantly associated with CI, right atrial pressure, peak oxygen uptake and the change of 6-minute walking distance using linear regression analysis. However, using logistic regression analysis baseline HbA1c-levels were not significantly associated with residual post-PEA PH. CONCLUSIONS: This is the first prospective study to describe an association of HbA1c-levels with pulmonary hemodynamics and exercise capacity in operable CTEPH patients. Our preliminary results indicate that in these patients impaired glucose metabolism as assessed by HbA1c is of clinical significance. However, HbA1c failed as a predictor of the hemodynamic outcome one-year post-PEA.