Analysis of the Ability of Different Allografts to Act as Carrier Grafts for Local Drug Delivery.

Bone defects and infections pose significant challenges for treatment, requiring a comprehensive approach for prevention and treatment. Thus, this study sought to evaluate the efficacy of various bone allografts in the absorption and release of antibiotics. A specially designed high-absorbency, high-surface-area carrier graft composed of human demineralized cortical fibers and granulated cancellous bone (fibrous graft) was compared to different human bone allograft types. The groups tested here were three fibrous grafts with rehydration rates of 2.7, 4, and 8 mL/g (F(2.7), F(4), and F(8)); demineralized bone matrix (DBM); cortical granules; mineralized cancellous bone; and demineralized cancellous bone. The absorption capacity of the bone grafts was assessed after rehydration, the duration of absorption varied from 5 to 30 min, and the elution kinetics of gentamicin were determined over 21 days. Furthermore, antimicrobial activity was assessed using a zone of inhibition (ZOI) test with S. aureus. The fibrous grafts exhibited the greatest tissue matrix absorption capacity, while the mineralized cancellous bone revealed the lowest matrix-bound absorption capacity. For F(2.7) and F(4), a greater elution of gentamicin was observed from 4 h and continuously over the first 3 days when compared to the other grafts. Release kinetics were only marginally affected by the varied incubation times. The enhanced absorption capacity of the fibrous grafts resulted in a prolonged antibiotic release and activity. Therefore, fibrous grafts can serve as suitable carrier grafts, as they are able to retain fluids such as antibiotics at their intended destinations, are easy to handle, and allow for a prolonged antibiotic release. Application of these fibrous grafts can enable surgeons to provide longer courses of antibiotic administration for septic orthopedic indications, thus minimizing infections.

[Regional geriatric care concept in the District of Lippe : Structural effects and network formation in the case management-based model project]. / Regionales Versorgungskonzept Geriatrie im Kreis Lippe : Struktureffekte und Netzwerkbildung im Case Management-basierten Modellprojekt.

BACKGROUND: Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. MATERIAL AND METHODS: The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring. RESULTS: Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care. CONCLUSION: In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.

[Geriatric case management at the kitchen table : Patient outcome of the pilot project for a regional geriatric care concept in the District of Lippe]. / Geriatrisches Case Management am Küchentisch : Patienten-Outcomes im Modellprojekt Regionales Versorgungskonzept Geriatrie im Kreis Lippe.

BACKGROUND: The interdisciplinary healthcare treatment of the elderly needs to consider their complex needs. There is a need for new structures of care to be tested, as in the model project regional geriatric care (RVG) concept. The aim is to qualitatively improve the treatment of elderly, multimorbid people by the implementation of case management and therefore to promote living in their own home and avoidance of the necessity for care. OBJECTIVE: How can the quality of care of a geriatric care concept be measured and the benefits for the target group be evaluated? MATERIALS AND METHODS: The explorative evaluation study reports patient outcomes for n = 380 participants who underwent geriatric assessment at the beginning of the intervention and again 12 months later. Descriptive and bivariate data analyses are reported. RESULTS: Participants of the RVG often had a greater need of support because of functional limitations. They rated their physical abilities, limitations and health mostly as being stable. The subjective mental well-being was significantly improved and satisfaction and acceptance by participants and their family members was high. CONCLUSION: The RVG care model enables a qualitatively improved geriatric care in the District of Lippe and considers the high potential for prevention. For organizing care and supporting independent living at home, it is more important to focus on the functional limitations of the elderly than on individual diseases. The tested concept for evaluation has limitations but serves as a basis for future clinical studies.