Evaluation of the functioning of long-term at-home nursing care in Poland from the perspective of care providers: Mixed methods study

AIMS AND OBJECTIVES

This study aimed to analyse and evaluate the functioning of long-term at-home nursing care (LTHNC) based on the opinions of its service providers.

BACKGROUND

Long-term at-home nursing care is a form of care for patients who do not need hospital treatment but need systematic nursing care because of their health problems. LTHNC in Poland involves guaranteed care services financed from universal health insurance contributions pursuant to contracts with the National Health Fund (NHF); the program has existed since 2004.

DESIGN

A sequential-explanatory mixed-method design was used. The study was carried out using both quantitative and qualitative research methods.

METHODS

A questionnaire was distributed amongst 1119 care providers (the response rate was 38.2%). The qualitative research comprised semi-structured interviews with ten care providers, namely three nurses managing LTHNC facilities and seven nurses directly providing services as part of LTHNC. The STROBE checklist was used in reporting this study.

RESULTS

We found that the main reasons for contracting LTHNC services were the increasing demand for this form of care, financial motives and an opportunity to introduce new organisational solutions. Our study shows that LTHNC is beneficial not only for the patients, but also for the nurses who provide the care. On the one hand, LTHNC provides positive results for patients and their caregivers (family members), and on the other hand, it affords a sense of satisfaction to the nurses and contributes to the development of their professional independence.

CONCLUSIONS

According to care providers, improving accessibility through increasing the number of contracted services as well as raising the pay for 1 day of care per patient may improve the functioning of LTHNC.

RELEVANCE TO CLINICAL PRACTICE

The results of our study are a source of information for those who organise health care and administer resources on how to improve the functioning of LTHNC.

Myriocin treatment affects lipid metabolism in skeletal muscles of rats with streptozotocin-induced type 1 diabetes

PURPOSE

The aim of this work was to assess the effect(s) of de novo ceramide synthesis inhibition on lipid metabolism in skeletal muscle tissue of type 1 diabetic rats. The latter seems to be of vital importance, since previous works have shown its positive influence on lipid metabolism and glucose homeostasis in the case of its counterpart - type 2 diabetes.

MATERIALS/METHODS

The animals were randomly assigned to one of the following groups: C - control, M - myriocin (ceramide de novo synthesis inhibitor), D - diabetes (induced by streptozotocin injections); D+M - diabetes+myriocin. We have evaluated intracellular concentration of key sphingolipid species, via chromatography (GC and HPLC), and the activity of their most important enzymes, using radiometric approach. The aforementioned assessments were evaluated in respect to the three different types of muscle tissue representing different spectra of muscle metabolism (soleus - oxidative, red gastrocnemious - oxidative-glycolytic, white gastrocnemious - glycolytic).

RESULTS

Interestingly, our therapeutic intervention not only lowered the level of ceramide, its precursors (sphinganine) and derivatives (sphingosine and sphingosine-1-phosphate), but also reduced other lipid species (triacylglycerols, diacylglycerols and free fatty acids) content, thus improving glucose homeostasis in type 1 diabetic animals.

CONCLUSIONS

In the light of the results ensuing from this study, it seems conceivable that the reduction of intramuscular ceramide production and accumulation could bestow an insulin-sensitizing effect. If so, then SPT inhibition could find potential future applications as a therapeutic intervention aimed to mitigate the effects of insulin resistance.

Insulin Resistance and Obesity Affect Lipid Profile in the Salivary Glands

In today's world wrong nutritional habits together with a low level of physical activity have given rise to the development of obesity and its comorbidity, insulin resistance. More specifically, many researches indicate that lipids are vitally involved in the onset of a peripheral tissue (e.g., skeletal muscle, heart, and liver) insulin resistance. Moreover, it seems that diabetes can also induce changes in respect of lipid composition of both the salivary glands and saliva. However, judging by the number of research articles, the salivary glands lipid profile still has not been sufficiently explored. In the current study we aim to assess the changes in the main lipid fractions, namely, triacylglycerols, phospholipids, free fatty acids, and diacylglycerols, in the parotid and the submandibular salivary glands of rats exposed to a 5-week high fat diet regimen. We observed that the high caloric fat diet caused a significant change in the salivary glands lipid composition, especially with respect to PH and TG, but not DAG or FFAs, classes. The observed reduction in PH concentration is an interesting phenomenon frequently signifying the atrophy and malfunctions in the saliva secreting organs. On the other hand, the increased accumulation of TG in the glands may be an important clinical manifestation of metabolic syndrome and type 2 diabetes mellitus.