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Introduction: The supply of medical aids is essential for patients with home mechanical ventilation. However, it is largely unclear to what extent this supply is needs-based and safe., Methods: As part of a health services research project, 20 expert interviews were conducted with a heterogeneous group of stakeholders related to ventilation-specific medical aids supply. The interviews were analysed using qualitative content analysis., Results: The interviewees pointed to challenges and problems regarding structural, procedural and personal aspects at all levels of medical aids supply. In particular, deficits in task performance, coordination and cooperation between the stakeholders and authorities involved became apparent. Such might result in avoidable safety risks and hinder needs-oriented supply of medical aids., Conclusion: Further development in ventilation-associated medical aids supply is needed, with focus on evidence-based practices, a comprehensive, cross-sectoral and cross-professional design as well as systematic evaluation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Maintaining safety is critical in home mechanical ventilation (HMV). It is co-determined by the availability of reliable technical aids and their correct application. Ensuring safe aid supply is part of the aid providers'́ legal mandate. However, whether and how this is achieved is largely unknown. Therefore, the tasks of technical aid providers, associated requirements and challenges with special regards to educational and safety aspects were investigated., Methods: For this purpose, episodic interviews were conducted between July and December 2020 with a purposive sample of field representatives of eleven technical aid providers. Between one and six persons participated in each of the interviews, resulting in a total sample of 25 persons (14 field representatives without management function, ten with management function, one director). Given the conditions during the COVID-19 pandemic, six interviews took place face-to-face and five as web meetings. Interviews were analysed using qualitative content analysis., Results: From the interviewees'́ perspective, the most important safety-related measure is the legally required and individually tailored initial instruction in a safe aid application. Additional safety-related tasks comprise counselling, e. g. for prescribing physicians and users (patients, relatives, nursing service employees), regular home visits, and the provision of a technical emergency service. Interviewees indicate that safety risks emerge primarily from a lack of skills and a high staff turnover among professional caregivers. This, they state, challenges building up and maintaining competencies among nursing staff. Other safety risks arise from healthcare fragmentation, lacking coordination, cooperation, and accountability of the professionals involved. Respondents address these challenges pragmatically by providing additional services, like ongoing caregiver training, care coordination and support roles., Discussion: Maintaining safety in ventilation-associated technical aid supply must be considered a crucial component of the overall HMV care processes, in which safety currently cannot be taken for granted. Field representatives of technical aid providers address the existing challenges with selective and intuitive strategies, some of which exceed their legal mandate., Conclusion: Improving safety in home care can be supported by establishing Advanced Nursing Practice roles in nursing services. The systematic further development of roles and tasks of staff of technical aid providers should be clarified within an overarching discourse on viable approaches to cross-sectoral and interprofessional HMV care., (Copyright © 2023. Published by Elsevier GmbH.)

Introduction: Both the availability and adequacy of infrastructure- and workforce capacity are critical to provide integrated and continuing care, especially to people with complex care needs such as those with invasive home mechanical ventilation (HMV). This review aims to synthesise indicators and norms that are available for assessing this infrastructure- and workforce capacity., Methods: A scoping review was conducted by searching PubMed, Livivo, the grey literature, specific registries, and the websites of relevant professional societies for international publications on specific infrastructure- and workforce capacity indicators or norms on HMV from January 2000 up to and including March 2021. Exclusion criteria comprised missing indicator/norm information, differing populations/care settings, and secondary literature. Indicators and norms were extracted, clustered, and analysed by applying the WHO Monitoring and Evaluation Framework and qualitative content analysis., Results: Fifteen publications met the inclusion criteria. Forty-five indicators and 44 norms on HMV-related infrastructure- and workforce capacity were synthesised. The synthesis revealed a heterogeneous set of indicators and norms (mainly from cross-sectional surveys and guidelines). The methodological information on their definition, rationales, disaggregation, and evidence is scarce., Conclusion: To enable integrated care in HMV and comparable populations with complex care needs, the identified limitations in assessing infrastructure- and workforce capacity should be addressed., (Copyright © 2023. Published by Elsevier GmbH.)

National and ethnic diversities among and within groups of migrants present great challenges to health care, not only in Germany. Access to regular health care, in particular for relatively small migrant groups and new immigrants is sometimes difficult. In addition, specific cultural aspects and legal implications--such as the residence status--must be taken into account when setting up a complementary system of health care. Methods and arrangements should make use of already existing resources of the health care system as well as proceed to direct cooperation with migrant communities. The public health service with its wide range of technical and organisational efficiency can play a key role here, especially in the municipal sector, both for an effective medical care for those who have difficulties in gaining access to the system, as well as for developing municipal networks, cooperating with a maximum number of medical service providers, organisations, and regarding specific migrant lifestyles. Social and ethic aspects of medical care for people living in precarious conditions ought to be supplemented by practice models which render a flexible and economic organisation of a complementary system of health care, the only way to a sustainable medical care for small migrant groups or not optimally integrated immigrant populations.

The goal is to describe the structure of administration for the control of infectious diseases in the German states. Internationally there is an increasing risk of potentially global transmission of infectious diseases and therefore increasing need for improved control mechanisms which are viable locally, regionally and internationally. The international public health community must ensure that responses to infectious disease with a potential impact on more than one county entail concerted action, clear communication and decision making by diverse administration agencies. Given Germany's federal structure, the 16 states have differing protocols delineating responsibilities for infection control systems. This paper provides an overview, going into detail only with regard to the administration structure in Hesse. In 2001, the German law governing infectious disease control was amended and significantly expanded. With regard to protection of humans from infectious disease, each state must define its schedule of responsibilities on the resulting scope of duties. Each state in Germany has entrusted the local public health service at the county level with the responsibility for infection prevention and control. As a rule, at the state level both an expert agency and one or more district administration agencies have been installed; these work directly with the Ministry of Health at the state level. In addition to this, Hesse has established a "centre of competence for highly contagious diseases." In the event of an infectious emergency, this network provides special treatment of highly infectious patients and expertise for public health services and the Ministry of Health on a 24-h shift basis. In times of ongoing structural transformation, it is important to emphasize that expertise at the state level is not an alternative to maintaining enough specialised personnel in the public health services themselves. Specialized practitioners are needed to ensure professional and fast-acting responses, both for the prevention and control of infectious diseases.