Search

Background General Practitioners (GPs) are the main providers of primary palliative care (PPC). At the same time they are the main initiators of specialised palliative homecare (SPHC). In Germany, little is known about factors which influence GPs in their involvement of SPHC. Aim of our study is to identify factors that drive GPs to give value to and involve SPHC. Methods A cross-sectional survey was performed. In 2018, questionnaires were mailed to 6000 randomly selected GPs from eight German federal states, focusing on the extent of GPs’ palliative care activities and their involvement of SPHC. Results With a response rate of 19.4% and exclusion of GPs working in SPHC-teams, n = 1026 questionnaires were appropriate for analysis. GPs valued SPHC support as the most “important/very important” for both “technical/invasive treatment measures” (95%) and availability outside practice opening hours (92%). The most relevant factor influencing perceived SPHC-importance was GPs’ self-reported extent of engagement in palliative care (β = − 0.283; CI 95% = − 0.384;−0.182), followed by the perceived quality of utilised SPHC (β = 0.119; CI 95% = 0.048;0.190), involvement in treatment of palliative patients after SPHC initiation (β = 0.088; CI 95% = 0.042;0.134), and conviction that palliative care should be a central part of GPs’ work (β = − 0.062; CI 95% = − 0.116;−0.008). Perceived SPHC-importance is also associated with SPHC-referrals (β =0.138; p Conclusions GPs with low reported activity in palliative care are more likely to initialise SPHC for palliative care activities they do not deliver themselves for various reasons, which might mean that the involvement of SPHC is substitutive instead of complementary to primary palliative care. This finding and its interpretation should be given more attention in the future policy framework for (specialised) palliative homecare. Trial registration German Clinical Trials Register DRKS00014726, 14.05.2018.

Fragestellung: In den vergangenen Jahren wurde eine stetig wachsende Anzahl von Knieendoprothesenimplantationen berichtet. Nach Verbesserung der Operationstechniken und Implantate sind perioperative Schmerztherapie und anästhesiologischen Methoden in den Fokus gerückt. Verschiedene Anästhesieverfahren[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

BACKGROUND Dipyrone (metamizole) is widely used for perioperative pain management in countries where it is marketed; however, uncertainty exists concerning the safe use of this drug, specifically considering the rare adverse event of an agranulocytosis. METHODS As evidence from published studies was lacking, an expert panel developed recommendations for the perioperative use of dipyrone. After a formal, structured consensus process, the recommendations were approved by the involved medical societies. RESULTS The panel agreed that blood cell counts shall not be standard for short-term perioperative use in patients unless they are at risk for neutropenia. The medical staff shall be aware of the symptoms and course of action when agranulocytosis is suspected. Patients shall be informed about the risks and benefits of dipyrone and about potential alternatives. The expert group concluded that dipyrone has a relatively positive risk-benefit ratio compared to other nonopioid analgesics. The group strongly recommended educating patients about the symptoms of agranulocytosis if they have received dipyrone over several days and/or treatment is to be continued after discharge, because agranulocytosis can occur several days after discontinuation of metamizole. Further recommendations refer to the information of the physician taking over the patient's care after discharge and the avoidance of re-exposure in patients having previously suffered from dipyrone-induced agranulocytosis. CONCLUSION The group's recommendations shall be communicated in order to raise medical staff's and patients' awareness of the appropriate use of dipyrone in the perioperative period.

Hintergrund und Fragestellung: In den letzten Jahren wurde über eine stetig steigende Anzahl von Hüftendoprothesenimplantationen berichtet. Verschiedene Anästhesieverfahren für den chirurgischen Eingriff selbst sowie Schmerz-Management-Programme wurden entwickelt. Es ist eines der[zum vollständigen Text gelangen Sie über die oben angegebene URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

Hintergrund: Viele Versterbende in Deutschland benötigen am Lebensende eine palliativmedizinische Betreuung. Dabei kann ein Großteil über die allgemeine ambulante Palliativversorgung (AAPV) durch niedergelassene Haus- oder Fachärzte erbracht werden. Ein Teil der Versterbenden bedarf[zum vollständigen Text gelangen Sie über die oben angegebene URL], 17. Deutscher Kongress für Versorgungsforschung (DKVF)

The objective of this study was to evaluate the influence of time of sample storage, method of analysis, and storage temperature on stability of HCT, HGB, and RBC in avian blood samples. Blood samples from mute swans were stored at 24°C or 4°C. Analyses of HCT, HGB, and RBC were carried out after 5 and 25 hours after collection of blood using both traditional and Cell-Dyn 3700 analyzer methods. Storage temperature had no significant influence on HCT, HGB, and RBC values of mute swan blood. However hematological parameters obtained by the traditional method were significantly lower than the results from the analyzer. Time of storage had a significant influence on values obtained traditionally for HCT, HGB, and RBC, but did not affect results that were obtained by the multi-parameter automated method. These results indicate that the mute swan blood can be stored at both room and refrigerator temperature. However, the analysis should be performed as soon as possible, especially in the case of traditional methods. Reference intervals for this species should always include information about the method used for hemogram determination and time elapsed since the blood collection.

Hintergrund: Hausärzte sind an der Versorgung von Menschen in ihrer letzten Lebensphase maßgeblich beteiligt. Sie verantworten zum einen die Maßnahmen der Allgemeinen Ambulanten Palliativversorgung (AAPV), zum anderen veranlassen sie nach Einschätzung der Bedarfslage die Verordnung[zum vollständigen Text gelangen Sie über die oben angegebene URL], 52. Kongress für Allgemeinmedizin und Familienmedizin