[SaxoForN-a transregional primary care research network in Dresden and Frankfurt am Main : Design of a practice-based research infrastructure]

Establishing primary care research networks (PCRNs) makes it easier to conduct clinical trials and health services research in a general-practice setting. Since February 2020, the German Federal Ministry of Education and Research (BMBF) has sponsored the development of six PCRNs and a coordination unit throughout Germany, with the aim of setting up a sustainable outpatient research infrastructure to raise the quantity and quality of primary care.The present article describes the design of a PCRN in Dresden and Frankfurt am Main - SaxoForN - and explains its structure and how it operates. The network is a transregional alliance between the two regional PCRNs named "SaxoN" (Dresden/Saxony) and "ForN" (Frankfurt am Main/Hesse), both of which run transregional and local research projects. For this purpose, joint standards and harmonized structures, for example with respect to the data infrastructure, qualifications, participation, and accreditation, were agreed upon and implemented at both sites.A critical success factor will be whether and to what extent the standards and structures, as well as resource planning, can be designed sustainably enough to permit the PCRNs to carry out high-quality research over the long term. To achieve this, the PCRNs will have to attract new practices and build up lasting relationships with them, qualify the research practices in order to standardize processes as far as possible, and regularly document their basic information and healthcare data.

Implementation and evaluation of a complex intervention to improve information availability at the interface between inpatient and outpatient care in older patients with multimorbidity and polypharmacy (HYPERION-TransCare) - study protocol for a pilot and feasibility cluster-randomized controlled trial in general practice in Germany

BACKGROUND

Despite attempts to improve the cross-sectoral flow of information, difficulties remain in routine healthcare. The resulting negative impact on continuity of care is often associated with poor health outcomes, especially in older patients. Our intervention aims to increase information availability with respect to medications and health conditions at the interface between inpatient and outpatient care and to contribute towards improving the quality of care in older patients. This pilot study focuses on feasibility and implementability.

METHODS

The idea of the complex intervention has been developed in a previous study. This intervention will be tested in a prospective, multicenter, cluster-randomized (via web tool), controlled pilot trial with two parallel study arms (intervention and control group). The pilot study will be conducted in 20 general practices in Hesse and Saxony (Germany) and include 200 patients (≥ 65 years of age with multimorbidity and polypharmacy) recruited by the practices. Practice staff and patients will be blinded. We will use qualitative and quantitative methods to assess the feasibility and implementability of the intervention and the study design in a process evaluation covering topics ranging from expectations to experiences. In addition, the feasibility of proposed outcome parameters for the future definitive trial will be explored. The composite endpoint will include health-related patient outcomes (hospitalization, falls, and mortality using, e.g., the FIMA questionnaire), and we will assess information on medications (SIMS questionnaire), symptoms and side effects of the medication (pro-CTCAE questionnaire), and health literacy (HLQ questionnaire). Data will be collected at study begin (baseline) and after 6 months. Furthermore, the study will include surveys and interviews with patients, general practitioners, and healthcare assistants.

DISCUSSION

The intervention was developed using a participatory approach involving stakeholders and patients. It aims to empower general practice teams as they provide patient-centered care and play a key role in the coordination and continuity of care. We aim to encourage patients to adopt an active role in their health care. Overall, we want to increase the availability of health-related information for patients and healthcare providers. The results of the pilot study will be used in the design and implementation of the future definitive trial.

TRIAL REGISTRATION

The study was registered in DRKS-German Clinical Trials Register: registration number DRKS00027649 (date: 19 January 2022). Date and version identifier 10.07.2023; Version 1.3.

Need-based care of multi-morbid patients - supporting general practitioners with algorithm-generated recommendations of healthcare services (telemedicine-project ATMoSPHÄRE)

Background

The patient-oriented and need-based care of multi-morbid patients with healthcare services and assistive products can be a highly complex task for the general practitioners (GPs). An algorithm-based digital recommendation system (DRS) for healthcare services was developed within the context of the telemedicine research project ATMoSPHÄRE. The plausibility of the DRS was tested and the results used to examine if, and to what degree, the DRS provides useful assistance to GPs.

Methods

The plausibility of the recommendations of the DRS were tested with the Delphi procedure (n = 8) and Interviews (n = 4) in collaboration with the GPs. They proposed services and assistive products they considered appropriate for two multi-morbid patients. Furthermore, GPs had to report whether, and to what degree they deemed the algorithm-generated recommendations appropriate. Significant quantitative differences between the GPs’, and the algorithm-generated, recommendations were evaluated with paired-samples-Wilcoxon-test.

Results

The first Delphi round revealed a high variability regarding the amount and character of services recommended by the physicians (1 to 10 recommendations, mean = 5.6, sd = 2.8). These professional recommendations converged after consideration of the algorithm-generated recommendations. The number of algorithm-generated recommendations which were judged as appropriate ranged between 7 and 17 of a total of 20 (mean = 11.9, sd = 2.5). The interviews revealed that the additional algorithm-generated recommendations which were judged appropriate contained mainly social care services.

Conlusion

The DRS provides GPs with additional appropriate recommendations for the need-based care of patients, which may not have been previously considered. It can therefore be assessed as a helpful complement in the primary care of multi-morbid patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01537-2.

A comparison of the gill physiology of two euryhaline crab species, Callinectes sapidus and Callinectes similis: energy production, transport-related enzymes and osmoregulation as a function of acclimation salinity

Callinectes sapidus and C. similis co-occur in estuarine waters above 15 salinity. Callinectes sapidus also inhabits more dilute waters, but C. similis is rarely found below 15 . Previous work suggests that C. sapidus may be a better hyperosmoregulator than C. similis. In this study, energy metabolism and the levels of transport-related enzymes in excised gills were used as indicators of adaptation to low salinity. Oxygen consumption rates and mitochondrial cytochrome content of excised gills increased in both species as acclimation salinity decreased, but to a significantly greater extent in C. similis gills. In addition, C. similis gills showed the same levels of carbonic anhydrase and Na+/K+-ATPase activities and the same degree of enzyme induction during low-salinity adaptation as has been reported for C. sapidus gills. However, hemolymph osmolality and ion concentrations were consistently lower in C. similis at low salinity than in C. sapidus. Therefore, although gills from low-salinity-acclimated C. similis have a higher oxygen consumption rate and more mitochondrial cytochromes than C. sapidus gills and the same level of transport-related enzymes, C. similis cannot homeostatically regulate their hemolymph to the same extent as C. sapidus.