Aufklärung zur Strahlentherapie: Patientenerwartungen und Auswirkung auf das Erleben der Strahlenbehandlung

Die Studie befasst sich mit dem Aufklärungsgespräch zur Strahlentherapie unter besonderer Berücksichtigung der Patientenperspektive. Es handelt sich um eine Kohortenstudie mit wiederholten Messungen (vor und nach dem Aufklärungsgespräch und nach Abschluss der Therapie). Die Kohorte bestand aus Krebspatienten, die in der Universitätsklinik Marburg ambulant strahlentherapeutisch behandelt wurden. Von insgesamt 137 Patienten durchliefen 63 Patienten die Studie komplett. Die Daten wurden teils anhand standardisierter Messinstrumente (EORTC QLQ-C30, PLC) und teils anhand selbsterstellter Fragen erhoben. Die Beobachtungsgruppe unterschied sich in demographischen Basisdaten (Alter, Geschlecht) und klinischen Kriterien (Diagnose, therapeutischer Ansatz) nicht signifikant vom Rest der Kohorte. Knapp 50% der Patienten kamen schon vorinformiert zum Aufklärungsgespräch, wobei Ärzte, Angehörige und Bekannte die wichtigsten Informationsquellen darstellten. Das Internet spielte eine untergeordnete Rolle. Die Patienten sorgten sich am häufigsten um das Thema Gesundheit/Krankheit (49%), gefolgt vom Thema Nebenwirkungen (22%). Die meisten (40%) Patienten verbanden neutrale Aspekte mit Strahlentherapie, 32% hatten positive Assoziationen (Hoffnung, Heilung) und 29% negative (z.B. z.B. Angst, Krebs). Die wichtigste Erwartung an das Aufklärungsgespräch war für 25% der Patienten Informationsgewinn, für 19% Aufbau von Vertrauen zum Arzt. Emotional betonte Aspekte, wie Angst mildern oder Beruhigung spielten kaum eine Rolle. 84% der Patienten sahen ihre Erwartungen bezüglich Informationsgewinn und Aufbau an Vertrauen nach dem Gespräch erfüllt. Insgesamt zeigten sich 73% sehr zufrieden und 27% nur mäßig bis wenig zufrieden. „Technische Informationen“ wie Bestrahlungsdauer oder Begleiterscheinungen waren nach dem Gespräch fast allen gut erinnerlich, während hinsichtlich Heilungsaussichten und Therapieziel z.T. unrealistische Erwartungen bestanden: obwohl nur zwei Drittel der Patienten mit kurativer Intention bestrahlt werden sollten, erwarteten 84% der Patienten Heilung. Hinsichtlich der Lebensqualität zeigte sich, dass diese bei der untersuchten Patientengruppe schlechter war als in der Allgemeinbevölkerung. Stärkere Unterschiede fanden sich bei der „Leistungsfähigkeit in Arbeit und Haushalt“ und in den Bereichen „soziales Leben“, „Müdigkeit“ und „Schlaflosigkeit“. Im Laufe der Therapie zeigte sich eine weitere Abnahme der Lebensqualität in den Bereichen „körperliche Leistungsfähigkeit“, „Müdigkeit“, „Schmerz“ und „Diarrhö“. Zwischen der Gesprächszufriedenheit und dem Erleben der Therapie fanden wir folgenden Zusammenhang: Je besser das Gespräch empfunden wurde, um so weniger unangenehm wurde die Strahlentherapie erlebt. Hohe Gesprächszufriedenheit führte zu weniger Nebenwirkungen, weniger Appetitlosigkeit, weniger Panik und weniger Einsamkeit. Das Gefühl, ausreichend informiert zu sein und Vertrauen zum Arzt gewonnen zu haben, führte zu weniger Nebenwirkungen, weniger Appetitlosigkeit und weniger Panik. Ergänzend wurden auch multivariate Analysen durchgeführt (in Vorbereitung auf eine englischsprachige Publikation und in dieser Arbeit nicht dargestellt), in denen Variablen wie negativer Affekt, Alter und Geschlecht als potentielle konfundierende Variablen berücksichtigt wurden (hierarchische Regressionen). Es zeigte sich, dass diese Kovariaten nur einen minimalen Beitrag zur Varianzaufklärung leisteten und der Effekt der Bewertung des Aufklärungsgespräches auf die Outcomevariablen nicht abgeschwächt wurde. In einer Nebenauswertung wurden diese Analysen nochmals für kurative und palliative Patienten getrennt vorgenommen. Für letztere war "Vertrauen zum Arzt fassen" das wichtigste Ziel des Aufklärungsgespräches. Gesprächszufirdenheit konnte Gefühle von Einsamkeit während der Therapie verringern. Schlussfolgerung: Das Aufklärungsgespräch stellt weit mehr als bloße Informationsübermittlung und juristische Absicherung des Arztes dar. Sind die Patienten mit dem Gespräch zufrieden und werden die zwei wichtigsten Wünsche der Patienten (Informiert werden und Vertrauen fassen) erfüllt, birgt es das Potential, die Strahlentherapie für den Patienten erträglicher zu machen: Nebenwirkungen werden weniger intensiv erlebt und die Patienten leiden unter weniger Panik und Einsamkeit. Somit kann es einen wichtigen Beitrag zur Verbesserung der Lebensqualität leisten. Bei Patienten mit palliativem Behandlungskonzept kann durch ein gelungenes Gespräch das Gefühl von Einsamkeit verringert werden

Production of Bioactive Volatiles by Different Burkholderia ambifaria Strains

Increasing evidence indicates that volatile compounds emitted by bacteria can influence the growth of other organisms. In this study, the volatiles produced by three different strains of Burkholderia ambifaria were analysed and their effects on the growth of plants and fungi, as well as on the antibiotic resistance of target bacteria, were assessed. Burkholderia ambifaria emitted highly bioactive volatiles independently of the strain origin (clinical environment, rhizosphere of pea, roots of maize). These volatile blends induced significant biomass increase in the model plant Arabidopsis thaliana as well as growth inhibition of two phytopathogenic fungi (Rhizoctonia solani and Alternaria alternata). In Escherichia coli exposed to the volatiles of B. ambifaria, resistance to the aminoglycoside antibiotics gentamicin and kanamycin was found to be increased. The volatile blends of the three strains were similar, and dimethyl disulfide was the most abundant compound. Sulfur compounds, ketones, and aromatic compounds were major groups in all three volatile profiles. When applied as pure substance, dimethyl disulfide led to increased plant biomass, as did acetophenone and 3-hexanone. Significant fungal growth reduction was observed with high concentrations of dimethyl di- and trisulfide, 4-octanone, S-methyl methanethiosulphonate, 1-phenylpropan-1-one, and 2-undecanone, while dimethyl trisulfide, 1-methylthio-3-pentanone, and o-aminoacetophenone increased resistance of E. coli to aminoglycosides. Comparison of the volatile profile produced by an engineered mutant impaired in quorum-sensing (QS) signalling with the corresponding wild-type led to the conclusion that QS is not involved in the regulation of volatile production in B. ambifaria LMG strain 1918

Defect in proline synthesis: pyrroline-5-carboxylate reductase 1 deficiency leads to a complex clinical phenotype with collagen and elastin abnormalities

Pyrroline-5-carboxylate reductase 1 (PYCR1) catalyzes the last step in proline synthesis. Deficiency of PYCR1, caused by a defect in PYCR1, was recently described in patients with cutis laxa, intrauterine growth retardation, developmental dysplasia of the hips and mental retardation. In this paper, we describe additional six patients (ages ranging from 4 months to 55 years) from four Iranian families with clinical manifestations of a wrinkly skin disorder. All patients have distinct facial features comprising triangular face, loss of adipose tissue and thin pointed nose. Additional features are short stature, wrinkling over dorsum of hand and feet, visible veins over the chest and hyperextensible joints. Three of the patients from a large consanguineous family do not have mental retardation, while the remaining three patients from three unrelated families have mental and developmental delay. Mutation analysis revealed the presence of disease-causing variants in PYCR1, including a novel deletion of the entire PYCR1 gene in one family, and in each of the other patients the homozygous missense mutations c.616G > A (p.Gly206Arg), c.89T > A (p.Ile30Lys) and c.572G > A (p.Gly191Glu) respectively, the latter two of which are novel. Light- and electron microscopy investigations of skin biopsies showed smaller and fragmented elastic fibres, abnormal morphology of the mitochondria and their cristae, and slightly abnormal collagen fibril diameters with irregular outline and variable size. In conclusion, this study adds information on the natural course of PYCR1 deficiency and sheds light on the pathophysiology of this disorder. However, the exact pathogenesis of this new disorder and the role of proline in the development of the clinical phenotype remain to be fully explaine

Fermi/LAT Observations of Swift/BAT Seyferts: on the Contribution of Radio-quiet AGN to the Extragalactic Gamma-ray Background

We present the analysis of 2.1 years of Fermi/LAT data on 491 Seyfert galaxies detected by the Swift/BAT survey. Only the two nearest objects, NGC 1068 and NGC 4945, which were identified in the Fermi First-year Catalog, are detected. Using the Swift/BAT and radio 20 cm fluxes, we define a new radio-loudness parameter $R_{X, BAT}$ where radio loud objects have $\log R_{X, BAT} > - 4.7$. Based on this parameter, only radio loud sources are detected by Fermi/LAT. An upper limit to the flux of the undetected sources is derived to be $\sim 2 \times 10^{-11}$ photons cm$^{-2}$ s$^{-1}$, approximately seven times lower than the observed flux of NGC 1068. Assuming a median redshift of 0.031, this implies an upper limit to the $\gamma$-ray (1--100 GeV) luminosity of $\lesssim 3 \times 10^{41}$ erg s$^{-1}$. In addition, we identified 120 new Fermi/LAT sources near the Swift/BAT Seyferts with significant Fermi/LAT detections. A majority of these objects do not have \bat counterparts, but their possible optical counterparts include blazars, FSRQs, and quasars.Comment: 19 pages preprint style, including 2 tables and 4 figures. Accepted for publication by the Astrophysical Journa

The web-based ASSO-food frequency questionnaire for adolescents: relative and absolute reproducibility assessment

Background: A new food frequency questionnaire (FFQ) has been recently developed within the Italian Adolescents and Surveillance System for the Obesity prevention (ASSO) Project; it was found to be appropriate for ranking adolescents in food and nutrient levels of intake. The aim of this study was to assess the relative and absolute reproducibility of the ASSO-FFQ for 24 food groups, energy and 52 nutrients. Methods: A test-retest study was performed on two ASSO-FFQs administered one month apart of each other to 185 adolescents, aged 14–17 and attending secondary schools in Palermo (Italy). Wilcoxon test assessed differences in median daily intakes between the two FFQs. Agreement was evaluated by quintiles comparison and weighted kappa. Intraclass Correlation Coefficients (ICC) and Bland-Altman method assessed the relative and absolute reliability respectively. Results: Significant difference (p < 0.05) in median intakes was found only for bread substitutes, savoury food, water, soft drinks, carbohydrates and sugar. The subjects classified into the same or adjacent quintiles for food groups ranged from 62% (white bread) to 91% (soft drinks); for energy and nutrients from 64% (polyunsaturated fatty acids) to 90% (ethanol). Mean values of weighted kappa were 0.47 and 0.48, respectively for food groups and nutrients. Fair to good ICC values (>0.40) were assessed for thirteen food groups, energy and forty-three nutrients. Limits of Agreement were narrow for almost all food groups and all nutrients. Conclusions: The ASSO-FFQ is a reliable instrument for estimating food groups, energy and nutrients intake in adolescents

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

BACKGROUND: The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. METHODS: A worldwide meta‐analysis of individual participant data from 20 634 hospitalised patients with laboratory‐confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. RESULTS: Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. CONCLUSIONS: Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support

Global burden of respiratory infections associated with seasonal influenza in children under 5 years in 2018: a systematic review and modelling study

Background: Seasonal influenza virus is a common cause of acute lower respiratory infection (ALRI) in young children. In 2008, we estimated that 20 million influenza-virus-associated ALRI and 1 million influenza-virus-associated severe ALRI occurred in children under 5 years globally. Despite this substantial burden, only a few low-income and middle-income countries have adopted routine influenza vaccination policies for children and, where present, these have achieved only low or unknown levels of vaccine uptake. Moreover, the influenza burden might have changed due to the emergence and circulation of influenza A/H1N1pdm09. We aimed to incorporate new data to update estimates of the global number of cases, hospital admissions, and mortality from influenza-virus-associated respiratory infections in children under 5 years in 2018. Methods: We estimated the regional and global burden of influenza-associated respiratory infections in children under 5 years from a systematic review of 100 studies published between Jan 1, 1995, and Dec 31, 2018, and a further 57 high-quality unpublished studies. We adapted the Newcastle-Ottawa Scale to assess the risk of bias. We estimated incidence and hospitalisation rates of influenza-virus-associated respiratory infections by severity, case ascertainment, region, and age. We estimated in-hospital deaths from influenza virus ALRI by combining hospital admissions and in-hospital case-fatality ratios of influenza virus ALRI. We estimated the upper bound of influenza virus-associated ALRI deaths based on the number of in-hospital deaths, US paediatric influenza-associated death data, and population-based childhood all-cause pneumonia mortality data in six sites in low-income and lower-middle-income countries. Findings: In 2018, among children under 5 years globally, there were an estimated 109·5 million influenza virus episodes (uncertainty range [UR] 63·1–190·6), 10·1 million influenza-virus-associated ALRI cases (6·8–15·1); 870 000 influenza-virus-associated ALRI hospital admissions (543 000–1 415 000), 15 300 in-hospital deaths (5800–43 800), and up to 34 800 (13 200–97 200) overall influenza-virus-associated ALRI deaths. Influenza virus accounted for 7% of ALRI cases, 5% of ALRI hospital admissions, and 4% of ALRI deaths in children under 5 years. About 23% of the hospital admissions and 36% of the in-hospital deaths were in infants under 6 months. About 82% of the in-hospital deaths occurred in low-income and lower-middle-income countries. Interpretation: A large proportion of the influenza-associated burden occurs among young infants and in low-income and lower middle-income countries. Our findings provide new and important evidence for maternal and paediatric influenza immunisation, and should inform future immunisation policy particularly in low-income and middle-income countries. Funding: WHO; Bill & Melinda Gates Foundation.Fil: Wang, Xin. University of Edinburgh; Reino UnidoFil: Li, You. University of Edinburgh; Reino UnidoFil: O'Brien, Katherine L.. University Johns Hopkins; Estados UnidosFil: Madhi, Shabir A.. University of the Witwatersrand; SudáfricaFil: Widdowson, Marc Alain. Centers for Disease Control and Prevention; Estados UnidosFil: Byass, Peter. Umea University; SueciaFil: Omer, Saad B.. Yale School Of Public Health; Estados UnidosFil: Abbas, Qalab. Aga Khan University; PakistánFil: Ali, Asad. Aga Khan University; PakistánFil: Amu, Alberta. Dodowa Health Research Centre; GhanaFil: Azziz-Baumgartner, Eduardo. Centers for Disease Control and Prevention; Estados UnidosFil: Bassat, Quique. University Of Barcelona; EspañaFil: Abdullah Brooks, W.. University Johns Hopkins; Estados UnidosFil: Chaves, Sandra S.. Centers for Disease Control and Prevention; Estados UnidosFil: Chung, Alexandria. University of Edinburgh; Reino UnidoFil: Cohen, Cheryl. National Institute For Communicable Diseases; SudáfricaFil: Echavarría, Marcela Silvia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Fasce, Rodrigo A.. Public Health Institute; ChileFil: Gentile, Angela. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Gordon, Aubree. University of Michigan; Estados UnidosFil: Groome, Michelle. University of the Witwatersrand; SudáfricaFil: Heikkinen, Terho. University Of Turku; FinlandiaFil: Hirve, Siddhivinayak. Kem Hospital Research Centre; IndiaFil: Jara, Jorge H.. Universidad del Valle de Guatemala; GuatemalaFil: Katz, Mark A.. Clalit Research Institute; IsraelFil: Khuri Bulos, Najwa. University Of Jordan School Of Medicine; JordaniaFil: Krishnan, Anand. All India Institute Of Medical Sciences; IndiaFil: de Leon, Oscar. Universidad del Valle de Guatemala; GuatemalaFil: Lucero, Marilla G.. Research Institute For Tropical Medicine; FilipinasFil: McCracken, John P.. Universidad del Valle de Guatemala; GuatemalaFil: Mira-Iglesias, Ainara. Fundación Para El Fomento de la Investigación Sanitaria; EspañaFil: Moïsi, Jennifer C.. Agence de Médecine Préventive; FranciaFil: Munywoki, Patrick K.. No especifíca;Fil: Ourohiré, Millogo. No especifíca;Fil: Polack, Fernando Pedro. Fundación para la Investigación en Infectología Infantil; ArgentinaFil: Rahi, Manveer. University of Edinburgh; Reino UnidoFil: Rasmussen, Zeba A.. National Institutes Of Health; Estados UnidosFil: Rath, Barbara A.. Vienna Vaccine Safety Initiative; AlemaniaFil: Saha, Samir K.. Child Health Research Foundation; BangladeshFil: Simões, Eric A.F.. University of Colorado; Estados UnidosFil: Sotomayor, Viviana. Ministerio de Salud de Santiago de Chile; ChileFil: Thamthitiwat, Somsak. Thailand Ministry Of Public Health; TailandiaFil: Treurnicht, Florette K.. University of the Witwatersrand; SudáfricaFil: Wamukoya, Marylene. African Population & Health Research Center; KeniaFil: Lay-Myint, Yoshida. Nagasaki University; JapónFil: Zar, Heather J.. University of Cape Town; SudáfricaFil: Campbell, Harry. University of Edinburgh; Reino UnidoFil: Nair, Harish. University of Edinburgh; Reino Unid

Neuraminidase Inhibitors and Hospital Length of Stay: A Meta-analysis of Individual Participant Data to Determine Treatment Effectiveness Among Patients Hospitalized With Nonfatal 2009 Pandemic Influenza A(H1N1) Virus Infection

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected]. BACKGROUND: The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear. METHODS: We conducted a one-stage individual participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (A[H1N1]pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS o