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Improving long-term patient and graft survival after liver transplantation (LT) remains a major challenge. Compared to the early phase after LT, long-term morbidity and mortality of the recipients not only depends on complications immediately related to the graft function, infections, or rejection, but also on medical factors such as de novo malignancies, metabolic disorders (e.g., new-onset diabetes, osteoporosis), psychiatric conditions (e.g., anxiety, depression), renal failure, and cardiovascular diseases. While a comprehensive post-transplant care at the LT center and the connected regional networks may improve outcome, there is currently no generally accepted standard to the post-transplant management of LT recipients in Germany. We therefore described the structure and standards of post-LT care by conducting a survey at 12 German LT centers including transplant hepatologists and surgeons. Aftercare structures and form of cost reimbursement considerably varied between LT centers across Germany. Further discussions and studies are required to define optimal structure and content of post-LT care systems, aiming at improving the long-term outcomes of LT recipients.
The complexity of atmospherical processes has always yielded a multitude of ways of knowing about the weather. What has been lacking in the historiography of meteorology so far is a way to formulate differences between forms of knowledge in a way that does not privilege modern scientific structures, but focuses instead on the epistemological category of causality. Using causality as ground of comparison for different knowledge claims, I shall argue, may enable researchers to investigate meteorological knowledge across time periods, perhaps even geographical regions, in a more symmetrical manner. This review demonstrates this approach as a means to organize a large set of historical meteorological writings from German countries between 1750 and 1850. Three distinct forms of knowledge (Semiotics, Physics, and Organics of the weather) during that time and in that region are suggested and will be described. While a bibliography with a national perspective from the 1880s was the basis for the selection of historical sources, such a setup proved awkward even to contemporaries. In addition, the bibliography came with a number of biases and shortcomings that will be critically reviewed.
In Germany, a grave labor shortage in the nursing and elderly care sectors has prompted the response of recruiting skilled nursing staff from abroad in recent years. This article analyzes these recruitment practices as forms of “migration management”: German migration policy has changed according to this paradigm to attempt utilitarian control over migration processes and mediate between labor market concerns on the one hand and isolationist, politico-cultural seclusion on the other. Based on original research through interviews and document analysis, we identify four relevant levels of analysis in researching migration management in the context of the recruitment of skilled nurses: (1) Definition of problem areas: How is migration programmatically legitimized as a solution to social problems? (2) Categorization of migration: How are migration processes classified? (3) Change in statehood: How are sites and actors of migration control being privatized and diversified? (4) Technologies: By means of which procedures, legal foundations and political instruments does migration management take place in the everyday? We believe that taking these four foci as points of departure would be beneficial for further inquiries in critical migration research.
Background: The health status, health awareness and health behavior of persons with a migration background often differ from the autochthonous population. Little is known about the proportion of patients with a migration background (PMB) that participate in primary care studies on oral antithrombotic treatment (OAT) in Germany, and whether the quality of their antithrombotic care differs from patients without a migration background. The aim of this paper was to use the results of a cluster-randomized controlled trial (PICANT) to determine the proportion of PMB at different stages of recruitment, and to compare the results in terms of sociodemographic characteristics and antithrombotic treatment.
Methods: This study used screening and baseline data from the PICANT trial on oral anticoagulation management in GP practices. For this analysis, we determined the proportion of PMB during the recruitment period at stage 1 (screening of potentially eligible patients), stage 2 (eligible patients invited to participate in the trial), and stage 3 (assessment of baseline characteristics of patients participating in the PICANT trial). In addition, we compared patients in terms of sociodemographic characteristics and quality of anticoagulant treatment. Statistical analysis comprised descriptive and bivariate analyses.
Results: The proportion of PMB at each recruitment stage declined from 9.1% at stage 1 to 7.9% at stage 2 and 7.3% at stage 3). A lack of German language skills led to the exclusion of half the otherwise eligible PMB. At stages 1 and 3, PMB were younger (stage 1: 70.7 vs. 75.0 years, p<0.001; stage 3: 70.2 vs. 73.5 years, p = 0.013), but did not differ in terms of gender. The quality of their anticoagulant care was comparable (100.0% vs. 99.1% were receiving appropriate OAT, 94.4% vs. 95.7% took phenprocoumon, or warfarin, and the most recent INR measurement of 60.8% vs. 69.3% was within their individual INR range).
Conclusions: In the potentially eligible population and among participants at baseline, the quality of anticoagulant care was high in all groups of patients, which is reassuring. To enable the inclusion of more PMB, future primary care research on OAT in Germany should address how best to overcome language barriers. This will be challenging, particularly because the heterogeneity of PMB means the resulting sample sizes for each specific language group are small.
Trial registration: Current Controlled Trials ISRCTN41847489.