[Quality measurement in long-term care facilities-the need for a systemic understanding]. / Qualitätsmessung in Einrichtungen der Langzeitpflege ­ Notwendigkeit eines systemischen Verständnisses.

In 2019, a new assessment tool for evaluating quality in long-term care facilities was introduced in Germany. The quality indicators are based on a linear understanding of quality, which appears obsolete in view of the many interacting influencing factors (actors, contextual factors). In the international literature, quality assurance in long-term care facilities is rather based on a systemic understanding of quality.This contribution to the discussion is to be classified against the background of the existing debate on quality assessment. Empirical results from two research projects supported by the Innovation Fund, Quality Measurement in Long-Term Care with Routine Data (QMPR) and Cross-Sector & Integrated Emergency and Care Management for the Last Phase of Life in Inpatient Long-Term Care (NOVELLE), are presented to highlight the complexity of quality in long-term care and to also point out the need to develop a systemic understanding of quality in long-term care in Germany. It is necessary to identify the diverse influencing factors in order to develop meaningful and robust quality indicators for long-term care.

[Temporary Employees in Nursing Care - Rising Costs, Lack of Social and Professional Acceptance, Missing Introductory and Training Programs]. / Der Einsatz von Leih- und Zeitarbeit in der Pflege ­ steigende Kosten, fehlende soziale und fachliche Akzeptanz, ausbleibende Einarbeitung und Kurzeinweisung.

AIM OF THE STUDY: There is greater deployment of external staff in the German health care system. In political debates as well as in demands of employers' organizations, economic aspects are raised. But the point of view of those affected should not be neglected. This paper aims to describe different perspectives of professional groups. METHODOLOGY: The empirical results are based on eleven partly structured interviews. These were subjected to Mayring's qualitative content analysis. The group of interviewees consists of representatives of the care sector, workforce representatives and personnel management. RESULTS: While employing temporary personnel in ward care of patients, economic, social and professional aspects should be taken into account by all professions involved in the German health care system. CONCLUSIONS: In discussions on this subject, besides rising costs, professional and social acceptance as well as training programs and special introductions are very important.

[Physical Activity and Cancer]. / Sporttherapie bei Krebs.

The value of physical activity in cancer prevention and therapy has been increasingly recognised during the last twenty years. Many patients suffer from a loss of physical performance and a decline in quality of life - with fatigue, anxiety and depression as a direct result of their disease and therapy. Since the 1990 s, there has been a substantial increase in scientific evidence demonstrating the positive effects of physical activity in cancer patients. This article presents an overview of the most important studies investigating the effects of physical activity for breast, colon, and prostate cancer.

Primary health care assessment by users with and without disabilities. / Avaliação da atenção primária em saúde por usuários com e sem deficiência.

PURPOSE: To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. METHODS: Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. RESULTS: Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. CONCLUSION: Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.

OBJETIVO: Avaliar atributos essenciais (acesso de primeiro contato, longitudinalidade, integralidade e coordenação da atenção) e derivados (orientação familiar e comunitária) da Atenção Primária em Saúde (APS) na percepção de usuários com e sem deficiência. MÉTODO: Estudo transversal observacional utilizando o questionário Primary Care Assesment Tool em usuários autodeclarados com e sem deficiência de cinco unidades básicas de saúde de um município no qual 55% da população depende do SUS. Foram atribuídos escores para as respostas dadas a cada atributo de atenção primária à saúde avaliado. RESULTADOS: Participaram 93 usuários (67 com e 26 sem deficiência). Não houve diferença estatisticamente significante para nenhum dos atributos na comparação entre pessoas com e sem deficiência. Para o grupo como um todo, obtiveram-se escores acima do critério de corte: Grau de afiliação, Acesso de primeiro contato (utilização), Longitudinalidade e Coordenação da atenção (sistema de informação). Receberam pior avaliação: Acesso de primeiro contato (acessibilidade), Coordenação da atenção (integralidade do cuidado), Integralidade (serviços disponíveis e prestados) e Orientação familiar e comunitária. Os usuários reconhecem que as equipes identificam problemas de locomoção e movimentação, mas que existem falhas no reconhecimento de problemas para ouvir, falar e enxergar; e na orientação das pessoas que necessitam de auxílio e das que prestam cuidados. CONCLUSÃO: Os usuários com e sem deficiência avaliaram de forma semelhante a atenção que recebem e indicaram fragilidades no reconhecimento de demandas específicas. Há necessidade de mudanças (estruturais e do processo de trabalho) para assegurar acessibilidade, integralidade do cuidado e orientação familiar e comunitária e, assim, melhor qualificar a APS.

Avaliação da atenção primária em saúde por usuários com e sem deficiência / Primary health care assessment by users with and without disabilities

RESUMO Objetivo Avaliar atributos essenciais (acesso de primeiro contato, longitudinalidade, integralidade e coordenação da atenção) e derivados (orientação familiar e comunitária) da Atenção Primária em Saúde (APS) na percepção de usuários com e sem deficiência. Método Estudo transversal observacional utilizando o questionário Primary Care Assesment Tool em usuários autodeclarados com e sem deficiência de cinco unidades básicas de saúde de um município no qual 55% da população depende do SUS. Foram atribuídos escores para as respostas dadas a cada atributo de atenção primária à saúde avaliado. Resultados Participaram 93 usuários (67 com e 26 sem deficiência). Não houve diferença estatisticamente significante para nenhum dos atributos na comparação entre pessoas com e sem deficiência. Para o grupo como um todo, obtiveram-se escores acima do critério de corte: Grau de afiliação, Acesso de primeiro contato (utilização), Longitudinalidade e Coordenação da atenção (sistema de informação). Receberam pior avaliação: Acesso de primeiro contato (acessibilidade), Coordenação da atenção (integralidade do cuidado), Integralidade (serviços disponíveis e prestados) e Orientação familiar e comunitária. Os usuários reconhecem que as equipes identificam problemas de locomoção e movimentação, mas que existem falhas no reconhecimento de problemas para ouvir, falar e enxergar; e na orientação das pessoas que necessitam de auxílio e das que prestam cuidados. Conclusão Os usuários com e sem deficiência avaliaram de forma semelhante a atenção que recebem e indicaram fragilidades no reconhecimento de demandas específicas. Há necessidade de mudanças (estruturais e do processo de trabalho) para assegurar acessibilidade, integralidade do cuidado e orientação familiar e comunitária e, assim, melhor qualificar a APS.

ABSTRACT Purpose To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. Methods Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. Results Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. Conclusion Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.

Preoperative radiological characterization of hepatic angiomyolipoma using magnetic resonance imaging and contrast-enhanced ultrasonography: a case report.

INTRODUCTION: A hepatic angiomyolipoma is a rare benign tumor of the liver composed of a mixture of smooth muscle cells, blood vessels and a variable amount of adipose tissue. Differentiating them from malignant liver tumors can often be very difficult. CASE PRESENTATION: We report the case of a 43-year-old Caucasian man presenting with a large liver mass in the right lobe. The results of magnetic resonance imaging and contrast-enhanced ultrasonography were consistent with a well-demarcated adipose tissue- containing tumor, showing prolonged hyperperfusion in comparison with the surrounding liver tissue. Surgery was performed and the diagnosis of hepatic angiomyolipoma was made with histopathology. CONCLUSION: Preoperative radiological characterization using magnetic resonance imaging and contrast-enhanced ultrasonography may improve diagnostic accuracy of hepatic angiomyolipoma. Identification of smooth muscle cells, blood vessels and adipose tissue with a positive immunohistochemical reaction for HMB-45 is the final evidence for an angiomyolipoma.

Correlation of routinely used coagulation parameters and presence of portal vein thrombosis in patients with liver cirrhosis.

AIM: Portal vein thrombosis (PVT) is a serious complication in patients with liver cirrhosis. In patients with advanced stages of liver cirrhosis plasmatic coagulation and platelet count are often reduced. However, patients with normal coagulation status might carry a high risk for developing PVT. A correlation between coagulation status used in clinical routine and the incidence of PVT in patients with liver cirrhosis has been evaluated in the present retrospective analysis. METHODS: 88 patients with liver cirrhosis were identified by screening a database. Of these patients, 23 suffered from PVT. Patients were classified according to the Child-Pugh classification. Patients were subdivided into early stages (Child A) and advanced stages (Child B/C) of liver cirrhosis. RESULTS: In patients with Child-Pugh A cirrhosis, there was no difference in activated partial thromboplastin time (apTT), international normalized ratio (INR), and platelet count between the PVT (n = 7) and the control group (n = 35). In contrast, the median apTT and INR were significantly lower in patients with Child B/C cirrhosis and PVT (n = 16) in comparison with patients without PVT (37 s vs 43 s [P = 0.017] and 1.25 vs 1.40 [P = 0.022]), respectively. Platelet count did not differ significantly in patients with advanced liver cirrhosis and PVT from those without PVT. CONCLUSION: Patients with advanced liver cirrhosis and PVT displayed lower apTT and INR compared with those without PVT. Therefore, patients with advanced liver cirrhosis and almost normal coagulation parameters might be at particular risk of developing PVT. The results suggest that regular monitoring using Doppler-ultrasound should be carried out in these patients, especially when liver transplantation is intended.

A distal region in the interferon-gamma gene is a site of epigenetic remodeling and transcriptional regulation by interleukin-2.

Interferon-gamma (IFN-gamma) is a multifunctional cytokine that defines the development of Th1 cells and is critical for host defense against intracellular pathogens. IL-2 is another key immunoregulatory cytokine that is involved in T helper differentiation and is known to induce IFN-gamma expression in natural killer (NK) and T cells. Despite concerted efforts to identify the one or more transcriptional control mechanisms by which IL-2 induces IFN-gamma mRNA expression, no such genomic regulatory regions have been described. We have identified a DNase I hypersensitivity site approximately 3.5-4.0 kb upstream of the transcriptional start site. Using chromatin immunoprecipitation assays we found constitutive histone H3 acetylation in this distal region in primary human NK cells, which is enhanced by IL-2 treatment. This distal region is also preferentially acetylated on histones H3 and H4 in primary Th1 cells as compared with Th2 cells. Within this distal region we found a Stat5-like motif, and in vitro DNA binding assays as well as in vivo chromosomal immunoprecipitation assays showed IL-2-induced binding of both Stat5a and Stat5b to this distal element in the IFNG gene. We examined the function of this Stat5-binding motif by transfecting human peripheral blood mononuclear cells with -3.6 kb of IFNG-luciferase constructs and found that phorbol 12-myristate 13-acetate/ionomycin-induced transcription was augmented by IL-2 treatment. The effect of IL-2 was lost when the Stat5 motif was disrupted. These data led us to conclude that this distal region serves as both a target of chromatin remodeling in the IFNG locus as well as an IL-2-induced transcriptional enhancer that binds Stat5 proteins.

Multiprobe ribonuclease protection assay for simultaneous measurement of mRNA expression.

The multiprobe RNase protection assay enables investigators to monitor RNA expression of 8-12 genes with as little as 1 microg of total RNA. The commercial availability of numerous multi-gene template sets makes this assay practical for all basic research programs.