'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial.

BACKGROUND: Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023. METHODS: A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50-70 informal caregivers (e.g. relatives, friends), and 30-40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data. DISCUSSION: This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings. TRIAL REGISTRATION: ISRCTN registry number is 25089186 . Date of trial registration is 16/11/2021.

Radioprotection by pretreatment with deuterated water: cytokinetic changes in the small intestine of the mouse.

All mice partially deuterated by ingestion of 29% heavy water for 12 days survived whole body gamma irradiation (8.5 Gy) from a 60Co source, whereas 42% of nondeuterated control animals died from bone marrow failure. The incorporation of 3HTdR into enterocytic DNA, as measured by autoradiography and liquid scintillation spectrometry, was used to assess the proliferative activity of small intestinal epithelium. The sequence and the magnitude of changes in tritium activity were in good agreement. Deuteration alone resulted in a reduced proliferative activity of small intestinal crypt epithelium, particularly in the basal cell positions and the first positions of the proliferation compartment. The number of positions occupied by the proliferative compartment and the crypt length were, however, barely affected by deuteration. The radiation-induced depression of DNA synthesis in the proliferative compartment was of similar magnitude in both groups. Crypt epithelium in deuterated mice, however, displayed signs of an accelerated and/or enhanced regeneration. The cytokinetic changes in deuterated animals are consistent with a protective effect for clonogenic intestinal epithelium at the time of irradiation.

Protection of mice from whole body gamma irradiation by deuteration of drinking water: hematologic findings.

Partial deuteration of mice by ingestion of 29% heavy water for 12 days prior to irradiation lessened their susceptibility to lethal doses of whole body gamma irradiation from a 60Co source. Deuteration alone slightly reduced the number of nucleated bone marrow cells, blood leukocytes, and platelets. After exposure to 8.5 Gy, all mice drank tap water. Radiation-induced destruction of hemopoietic and lymphoid tissues was of equal degree in deuterated and control animals. Conversely, nucleated bone marrow cells, blood leukocytes and platelets, endogenous spleen colonies, and thymus of deuterated mice displayed signs of an accelerated and/or enhanced regeneration. The cytokinetic changes observed in deuterated animals were consistent with a protective effect for pluripotent stem cells at the time of irradiation.

Protection of mice from whole-body gamma radiation by deuteration of drinking water.

Drinking water made available to mice was changed from ordinary tap water to tap water containing 30 atom% D2O when the animals were 6 to 8 weeks old. Twelve days later, the deuterated mice and an approximately equal number of nondeuterated control mice were subjected to whole-body gamma radiation from a 60Co source. All mice received ordinary tap water after the irradiation. Postirradiation mortality was significantly less in deuterated than in nondeuterated animals. These results may have practical implications for radiotherapy of human malignant tumors.

[Xerography in the facio-maxillary region (author's transl)]. / Erfahrungen mit der Xeroradiographie im Kiefer-Gesichts-Bereich.

The basis and characteristics of xerography, which was introduced into medicine in 1971 for examining bones and soft tissues, are described. The advantages and disadvantages as compared with conventional film techniques are mentioned. The application of xeroradiography in the facio-maxillary region is discussed in relation to our own experience.

[Quantitative Coombs' test in autoimmune hemolytic anemia]. / Test de Coombs quantitatif dans l'anémie auto-immunohémolytique

The detection of iso- and autoantibodies to red cells and complement on the surface of erythrocytes has been studied in a continuous flow system using a single channel autoanalyzer. A macromolecule, polyvinyl pyrrolidone, is added to the washed cells in order to increase their aggregability. With this system it is possible to establish a direct relationship between the quantity of antibodies present on the surface of the cells and the red cells agglutinated by an antiglobulin serum. By this method it is possible to evaluate the degree of autoantibody coating of erythrocytes in autoimmune hemolytic anemia, and to adjust therapy accordingly.

[Velo-pharyngeal closure before and after adenotomy and tonsillectomy]. / Der Gaumen-Rachen-Verschluss vor und nach der Adenotomie und Tonsillektomie

Prior to and after removal of the tonsils and adenoids at the ENT clinic in Lucerne, phoniatric and X-ray examinations were performed in 42 children with normal velo-pharyngeal closure. Prior to the operation the velo-pharyngeal closure took place against the adenoid tissue. The surface of contact and the inclinatation of the velum were dependent on the amount of hyperplastic adenoid tissue. The configuration and the mobility of the velum were more important for the post-operative velo-pharyngeal closure than the distance from the pharyngeal wall. 3 months following the operation the velum was reaching the posterior pharyngeal wall. A distinct Passavant ridge was only visible in cases having slight difficulties in the post-operative adaptation of the velo-pharyngeal closure.