Challenges in supporting lay carers of patients at the end of life: results from focus group discussions with primary healthcare providers

Background: Family caregivers (FCGs) of patients at the end of life (EoL) cared for at home receive support from professional and non-professional care providers. Healthcare providers in general practice play an important role as they coordinate care and establish contacts between the parties concerned. To identify potential intervention targets, this study deals with the challenges healthcare providers in general practice face in EoL care situations including patients, caregivers and networks. Methods: Focus group discussions with general practice teams in Germany were conducted to identify barriers to and enablers of an optimal support for family caregivers. Focus group discussions were analysed using content analysis. Results: Nineteen providers from 11 general practices took part in 4 focus group discussions. Participants identified challenges in communication with patients, caregivers and within the professional network. Communication with patients and caregivers focused on non-verbal messages, communicating at an appropriate time and perceiving patient and caregiver as a unit of care. Practice teams perceive themselves as an important part of the healthcare network, but also report difficulties in communication and cooperation with other healthcare providers. Conclusion: Healthcare providers in general practice identified relational challenges in daily primary palliative care with potential implications for EoL care. Communication and collaboration with patients, caregivers and among healthcare providers give opportunities for improving palliative care with a focus on the patient-caregiver dyad. It is insufficient to demand a (professional) support network; existing structures need to be recognized and included into the care

Hyperspectral image analysis techniques for the detection and classification of the early onset of plant disease and stress

This review explores how imaging techniques are being developed with a focus on deployment for crop monitoring methods. Imaging applications are discussed in relation to both field and glasshouse-based plants, and techniques are sectioned into ‘healthy and diseased plant classification’ with an emphasis on classification accuracy, early detection of stress, and disease severity. A central focus of the review is the use of hyperspectral imaging and how this is being utilised to find additional information about plant health, and the ability to predict onset of disease. A summary of techniques used to detect biotic and abiotic stress in plants is presented, including the level of accuracy associated with each method

The size of the population potentially in need of palliative care in Germany - an estimation based on death registration data

BACKGROUND: No data exist on the size of the population potentially in need of palliative care in Germany. The aim of this study is to estimate the size of the German population that may benefit from palliative care. METHOD: Based on existing population-based methods (Rosenwax and Murtagh), German death registration data were analyzed and contrasted with international results. The data include all death cases in 2013 in Germany. RESULTS: According to the method Rosenwax defined, between 40.7 % (minimal estimate) and 96.1 % (maximal estimate) of death cases could benefit from palliative care. The estimation, based on Murtagh’s refined method, results in 78.0 % of death cases potentially being eligible for palliative care. The percentage of potential palliative care candidates is conditioned by age. Based on the Murtagh Method, in the age category between 30 and 39 years, a potential demand for palliative care can be found for 40.4 % percent of all deaths occurring in this age category, with this number increasing to 80.3 % in the age bracket of 80 years and over. CONCLUSION: An estimation of the size of the population in need is essential for healthcare planning. Therefore, our data serve as a guide and starting point for further research

Non-response in a survey of physicians on end-of-life care for the elderly

<p>Abstract</p> <p>Background</p> <p>Physicians are quite often surveyed with the aim to investigate their opinions regarding provision and improvement of health care. However, in many cases response rates tend to be rather low. The aim of the study is to reflect methodological aspects regarding survey conduction and to analyse factors that cause physicians to take part in a study on delivering end-of-life care for the elderly.</p> <p>Methods</p> <p>N = 4,727 physicians in Lower Saxony, Germany, received a standardised questionnaire on their attitudes about end-of-life care for the elderly. Non-responders were asked to state the reasons for non-participation. Comparison of the sociodemographic characteristics between responders and non-responders, and evaluation of the reasons for non-participation were made.</p> <p>Results</p> <p>The response rate to the questionnaire on end-of-life care for the elderly was 40% (n = 1,892). Of the non-responders to the questionnaire, 12.8% (n = 364) stated the reasons for non-participation. Overall, the response rate to the questionnaire varied with specialty and location of the practice: radiotherapists answered significantly more frequently than other categories of physician (e.g. general practitioners) and physicians in rural areas significantly more frequently than their colleagues in urban areas. The reasons most frequently given for non-participation were "Not concerned with the subject" and "No time".</p> <p>Conclusions</p> <p>The varying rates of response indicate that the survey was not sufficiently relevant to all groups of physicians, or that the awareness of the topic may be partly underdeveloped.</p

How to Win First-Order Safety Games

First-order (FO) transition systems have recently attracted attention for the verification of parametric systems such as network protocols, software-defined networks or multi-agent workflows like conference management systems. Functional correctness or noninterference of these systems have conveniently been formulated as safety or hypersafety properties, respectively. In this article, we take the step from verification to synthesis---tackling the question whether it is possible to automatically synthesize predicates to enforce safety or hypersafety properties like noninterference. For that, we generalize FO transition systems to FO safety games. For FO games with monadic predicates only, we provide a complete classification into decidable and undecidable cases. For games with non-monadic predicates, we concentrate on universal first-order invariants, since these are sufficient to express a large class of properties---for example noninterference. We identify a non-trivial sub-class where invariants can be proven inductive and FO winning strategies be effectively constructed. We also show how the extraction of weakest FO winning strategies can be reduced to SO quantifier elimination itself. We demonstrate the usefulness of our approach by automatically synthesizing nontrivial FO specifications of messages in a leader election protocol as well as for paper assignment in a conference management system to exclude unappreciated disclosure of reports