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Background: In primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.
Methods: This cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).
Results: The overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.
Conclusions: This study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.
The exact pathophysiology of contrast-induced nephropathy (CIN) is not fully clarified, yet the osmotic characteristics of contrast media (CM) have been a significant focus in many investigations of CIN. Osmotic effects of CM specific to the kidney include transient decreases in blood flow, filtration fraction, and glomerular filtration rate. Potentially significant secondary effects include an osmotically induced diuresis with a concomitant dehydrating effect. Clinical experiences that have compared the occurrence of CIN between the various classes of CM based on osmolality have suggested a much less than anticipated advantage, if any, with a lower osmolality. Recent animal experiments actually suggest that induction of a mild osmotic diuresis in association with iso-osmolar agents tends to offset potentially deleterious renal effects of high viscosity-mediated intratubular CM stagnation.
Carinostoma elegans new to the Slovakian harvestmen fauna (Opiliones, Dyspnoi, Nemastomatidae)
(2014)
A new genus and species of small harvestman was found for the first time in Slovakia – Carinostoma elegans (Sorensen, 1894). One male and two females were collected in the Mlyňany arboretum of the Slovak Academy of Science (western Slovakia). Descriptions and photographs of both sexes of C. elegans are provided. Additional comments, and a map of distribution of all species of this genus, are provided.
Sauron rayi (Simon, 1881) is recorded in Austria for the first time. Male and female specimens of this rare European spider were found in two “Austrian pine forests” in Lower Austria. Data on distribution, habitat, phenology and Red List status from the Austrian localities and from published records in other countries are presented.
Jörg Wunderlich wurde am 19. Dezember 1939 in Berlin geboren. Nach dem zweiten Weltkrieg befand sich seine Familie im Osten des Landes, es gelang ihr aber 1951 nach West-Berlin zu ziehen. Aufgrund der mangelnden schulischen Ausbildung in der Nachkriegszeit und der unterschiedlichen Schulprogramme im Osten (Russisch) und Westen (Latein und Englisch) schloss Jörg die Schule im Alter von 20 Jahren ab.
Danach begann er an der Freien Universität Berlin zunächst Mathematik zu studieren, wechselte aber bald zu Biologie, Geographie, Politikwissenschaften und Philosophie. Insgesamt verbrachte er acht Jahre an der Universität. Währenddessen übernahm er Jobs um sich seinen Lebensunterhalt zu finanzieren. Seine Staatsexamensarbeit an der Freien Universität war eine ökologische Studie über die Zwergspinnenfauna der Pfaueninsel in Berlin, einem Naturschutzgebiet, in dem er über 300 Webspinnenarten in verschiedenen Habitaten nachwies, zwei davon neu für die Wissenschaft (Glyphesis taoplesius, Moebelia berolinensis).
Die Springspinne Evarcha michailovi Logunov, 1992 wird erstmalig für Deutschland von einem ehemaligen Truppenübungsplatz im Süden Mecklenburg-Vorpommerns gemeldet. Gleichzeitig werden Erstnachweise der Springspinnen Evarcha laetabunda (C. L. Koch, 1846), Philaeus chrysops (Poda, 1761) und Sitticus inexpectus Logunov & Kronestedt, 1997, der Haubennetzspinne Crustulina sticta (O. P.-Cambridge, 1861) sowie der Krabbenspinne Heriaeus graminicola (Doleschall, 1852) erbracht.