Background General practitioners (GPs) play a significant role in providing medical care to patients affected by the coronavirus disease 2019 (COVID-19). Little is known about the impact of the pandemic on patient care from the perspective of GPs. Objectives To gain insight into GPs’ experiences of the COVID-19 pandemic and its impact on patient care in Germany. Methods From August to December 2020, qualitative, semi-structured telephone interviews were conducted with 22 GPs from four randomly selected federal states in Germany. We analysed the data according to Kuckartz’s method of content analysis. Results Five themes emerged: changes in healthcare system, practice routines, patient care, personal life, and improving health crisis preparedness. Communication with authorities and following rapidly changing guidelines were the biggest challenges during the pandemic. Teamwork and collegial exchange in the practice were seen as important sources of support to overcome these barriers. Participants stated that they managed to secure care but expressed concerns about how social distancing might affect the doctor-patient relationship. In their professional and private lives, GPs perceived themselves as role models with a high responsibility for the health of others. Consistent guidance by health authorities and reliable information were raised as necessary for managing patient care in the pandemic. Conclusion Findings show that patient care was successful but GPs’ adaptation to unprecedented conditions was limited by poor communication and collaboration with health authorities. Therefore, providing adequate support services by policymakers is essential to strengthen primary care in future health crises.
Excessive activation of cardiac fibroblasts (CFs) in response to injury provokes cardiac fibrosis, stiffness, and failure. The local mediators counterregulating this response remain unclear. Exogenous C-type natriuretic peptide (CNP) exerts antifibrotic effects in preclinical models. To unravel the role of the endogenous hormone, we generated mice with fibroblast-restricted deletion (KO) of guanylyl cyclase-B (GC-B), the cGMP-synthesizing CNP receptor. CNP activated GC-B/cGMP signaling in human and murine CFs, preventing proliferative and promigratory effects of angiotensin II (Ang II) and TGF-β. Fibroblast-specific GC-B–KO mice showed enhanced fibrosis in response to Ang II infusions. Moreover, after 2 weeks of mild pressure overload induced by transverse aortic constriction (TAC), such KO mice had augmented cardiac fibrosis and hypertrophy, together with systolic and diastolic contractile dysfunction. This was associated with increased expression of the profibrotic genes encoding collagen I, III, and periostin. Notably, such responses to Ang II and TAC were greater in female as compared with male KO mice. Enhanced Ang II–induced CNP expression in female hearts and augmented GC-B expression and activity in female CFs may contribute to this sex disparity. The results show that paracrine CNP signaling in CFs has antifibrotic and antihypertrophic effects. The CNP/GC-B/cGMP pathway might be a target for therapies combating pathological cardiac remodeling.
ObjectivesAlthough the vast majority of COVID-19 cases are treated in primary care, patients' experiences during home isolation have been little studied. This study aimed to explore the experiences of patients with acute COVID-19 and to identify challenges after the initial adaptation of the German health system to the pandemic (after first infection wave from February to June 2020).MethodsA mixed-method convergent design was used to gain a holistic insight into patients experience. The study consisted of a cross-sectional survey, open survey answers and semi-structured telephone interviews. Descriptive analysis was performed on quantitative survey answers. Between group differences were calculated to explore changes after the first infection wave. Qualitative thematic analysis was conducted on open survey answers and interviews. The results were then compared within a triangulation protocol.ResultsA total of 1100 participants from all German states were recruited by 145 general practitioners from August 2020 to April 2021, 42 additionally took part in qualitative interviews. Disease onset varied from February 2020 to April 2021. After the first infection wave, more participants were tested positive during the acute disease (88.8%; 95.2%; P < 0.001). Waiting times for tests (mean 4.5 days, SD 4.1; 2.7days, SD 2.6, P < 0.001) and test results (mean 2.4 days, SD 1.9; 1.8 days, SD 1.3, P < 0.001) decreased. Qualitative results indicated that the availability of repeated testing and antigen tests reduced insecurities, transmission and related guilt. Although personal consultations at general practices increased (6.8%; 15.5%, P < 0.001), telephone consultation remained the main mode of consultation (78.5%) and video remained insignificant (1.9%). The course of disease, the living situation and social surroundings during isolation, access to health care, personal resilience, spirituality and feelings of guilt and worries emerged as themes influencing the illness experience. Challenges were contact management and adequate provision of care during home isolation. A constant contact person within the health system helped against feelings of care deprivation, uncertainty and fear.ConclusionsOur study highlights that home isolation of individuals with COVID-19 requires a holistic approach that considers all aspects of patient care and effective coordination between different care providers.
Zusammenfassung Ziel der Studie Die erste COVID-19-Pandemiewelle (März–April 2020) hat die hausärztliche Versorgung vor große Herausforderungen gestellt. Ziel der Studie war es zu untersuchen, wie belastend HausärztInnen die Krisensituation zu Pandemiebeginn und im weiteren Pandemieverlauf erlebt haben. Zusätzlich sollten prädiktive Faktoren für das Überforderungsgefühl identifiziert werden. Methode Von August bis Oktober 2020 erfolgte eine Querschnittsbefragung von Hausarztpraxen in vier Bundesländern zur Versorgungsrealität sowie zu psychischen Belastungen im Rahmen der Coronapandemie. Insgesamt 6300 zufällig ausgewählte HausärztInnen wurden angeschrieben. Ergebnisse Die Rücklaufquote betrug 23%. 46% der Teilnehmenden waren weiblich. 40% der Teilnehmenden gaben an, zu Beginn der Pandemie unter einem großen oder sehr großen Überforderungsgefühl gelitten zu haben, zum Befragungszeitpunkt äußerten dies nur noch 10%. Mit steigender Anzahl der COVID-19-PatientInnen nahm das Gefühl der Überforderung zu; gleichzeitig stieg auch die selbst eingeschätzte Kompetenz, COVID-19-PatientInnen zu versorgen. Unter anderem trugen eine hohe psychische Belastung, hoher Organisationsaufwand, eine schlechte selbsteingeschätzte Kompetenz bei der Versorgung von COVID-19-PatientInnen und mangelnde Versorgung mit Schutzausrüstung zum Überforderungserleben der HausärztInnen bei. Schlussfolgerung Trotz anfänglicher Überforderung fühlten sich HausärztInnen zunehmend kompetent in der Versorgung von COVID-19-PatientInnen. Um HausärztInnen in Krisensituationen zukünftig besser zu unterstützen, sollten organisatorische Tätigkeiten möglichst vereinfacht werden, um das Augenmerk auf die PatientInnenversorgung legen zu können.
Background PCR testing is considered the gold standard for SARS-CoV-2 diagnosis but its results are earliest available hours to days after testing. Rapid antigen tests represent a diagnostic tool enabling testing at the point of care. Rapid antigen tests have mostly been validated by the manufacturer or in controlled laboratory settings only. External validation at the point of care, particularly in general practice where the test is frequently used, is needed. Furthermore, it is unclear how well point of care tests are accepted by the practice staff. Methods In this prospective multicenter validation study in primary care, general practitioners included adult individuals presenting with symptoms suggesting COVID-19. Each patient was tested by the general practitioner, first with a nasopharyngeal swab for the point of care test (Roche SARS-CoV-2 Rapid Antigen Test) and then with a second swab for PCR testing. Using the RT-PCR result as a reference, we calculated specificity, sensitivity, positive predictive value and negative predictive value, with their 95% confidence intervals. General practitioners and medical assistants completed a survey to assess feasibility and usefulness of the point of care tests. Results In 40 practices in Würzburg, Germany, 1518 patients were recruited between 12/2020 and 06/2021. The point of care test achieved a sensitivity of 78.3% and a specificity of 99.5% compared to RT-PCR. With a prevalence of 9.5%, the positive predictive value was 93.9% and the negative predictive value was 97.8%. General practitioners rated the point of care test as a helpful tool to support diagnostics in patients with signs and symptoms suggestive for infection, particularly in situations where decision on further care is needed at short notice. Conclusion The point of care test used in this study showed a sensitivity below the manufacturer’s specification (Sensitivity 96.25%) in the practice but high values for specificity and high positive predictive value and negative predictive value. Although widely accepted in the practice, measures for further patient management require a sensitive interpretation of the point of care test results.
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