Breast und Cancer Care Nurse: Ein Modell für spezialisierte Pflege in Brust- und Tumorzentren

Zusammenfassung: Durch die Veränderung der Versorgungsstrukturen von Patientinnen mit gynäkologischen, malignen Tumoren verändert sich der Bedarf an pflegerischer Versorgung. Im skandinavischen und angloamerikanischen Raum bereits etablierte Breast und Cancer Care Nurses halten im deutschsprachigen Raum Einzug. Der Artikel beschreibt das Modell der Breast und Cancer Care Nurse (BCNI) des Brust- und Tumorzentrums der Frauenklinik des Inselspitals, Universitätsspital in Bern. Die Einbindung der BCNI in das multidisziplinäre Team wird anhand eines Prozessplans erläutert. Möglichkeiten der Kompetenzentwicklung von spezialisierten Pflegefachpersonen werden diskutiert. Konkrete Inhalte des Angebotes werden anhand von Beispielen aus Beratungskonzepten erläutert. Erste Ergebnisse aus der Qualitätsevaluation der Einführung der BCNI werden dargestell

Survey of laying hen husbandry in Switzerland

In Switzerland eggs have not been produced in battery cages since January 1992. During the 10 year period from 1981 farmers replaced their battery cages with deep litter, aviary and grid-floor systems and modified cages. However, the cages used to replace the conventional battery cages and most of the grid- floor systems did not fulfil the requirements of the Swiss Welfare Act and they were not permitted to be advertised or sold thereafter. Sixteen years after the ban on battery cages, the Federal Veterinary Office has undertaken a survey to determine how laying hens are kept in Switzerland and how the alternative systems have fared. The survey was carried out on 96 randomly chosen farms with at least 500 hen places to find out more about the housing conditions, management processes, status and performance of hens. The results show that aviaries are very common in Switzerland (65% of the laying hens) and that the laying performance in these systems is significantly higher than that in grid- floor systems and similar to that in battery cages. Provision of a protected outdoor area is a valuable benefit. To be successful with aviary systems it is necessary for pullets to spend the rearing period under similar housing condition

Structural and functional aspects of the multidrug efflux pump AcrB

The tripartite efflux system AcrA/AcrB/TolC is the main pump in Escherichia coli for the efflux of multiple antibiotics, dyes, bile salts and detergents. The inner membrane component AcrB is central to substrate recognition and energy transduction and acts as a proton/drug antiporter. Recent structural studies show that homotrimeric AcrB can adopt different monomer conformations representing consecutive states in an allosteric functional rotation transport cycle. The conformational changes create an alternate access drug transport tunnel including a hydrophobic substrate binding pocket in one of the cycle intermediate

Experimental investigation of open-ended microwave oven assisted encapsulation process

An open ended microwave oven is presented with improved uniform heating, heating rates and power conversion efficiency. This next generation oven produces more uniform EM fields in the evanescent region forming part of the heating area of the oven. These fields are vital for the rapid and uniform heating of various electromagnetically lossy materials. A fibre optic temperature sensor and an IR pyrometer are used to measure in situ and in real-time the temperature of the curing materials. An automatic computer controlled closed feedback loop measures the temperature in the curing material and drives the microwave components to obtain predetermined curing temperature cycles for efficient curing. Uniform curing of the lossy encapsulants is achieved with this oven with typical cure cycle of 270 seconds with a ramp rate of 1oC/s and a hold period of 2 minutes. Differential scanning calorimeter based measurement for the pulsed microwave based curing of the polymer dielectric indicates a ~ 100% degree of cure

Efficacy of oral administration of specific immunoglobulins in preventing neonatal calf diarrhoea in dairy herds.

BACKGROUND The aim of this study was to evaluate the efficacy of bovine concentrated lactoserum (BCL) containing specific immunoglobulin G against Escherichia coli, rotavirus and coronavirus in preventing neonatal calf diarrhoea (NCD). METHODS A total of 489 newborn calves from 35 herds were orally given either BCL or a placebo before the first feeding of colostrum and clinically supervised by the farmers for the first 14 days of life. The diarrhoea score was defined according to the following criteria: 0 = no diarrhoea; 1 = light diarrhoea without medical treatment; 2 = diarrhoea requiring oral treatment (rehydration and/or antibiotic therapy); and 3 = severe diarrhoea requiring parenteral rehydration or resulting in death. RESULTS A total of 138 calves suffered from diarrhoea (28%), and 65 (13%) showed signs of diarrhoea requiring treatment. The odds of getting NCD were reduced (odds ratio = 0.326; p < 0.001) in the BCL group. There was a tendency towards a reduction in the duration of NCD in the BCL group (2.25 (±1.7) days vs. 2.88 (±2.7) days in the placebo group) (p = 0.052). Furthermore, no calves died in the BCL group, whereas four calves died in the placebo group. LIMITATIONS Because of the design of the study using animals in practice, the mechanisms explaining the clinical findings remain as hypotheses. Diarrhoea scoring performed by farmers has to be analysed and interpreted with caution. CONCLUSIONS This study demonstrates that BCL as a single preventive treatment is effective in reducing the incidence of NCD even in a region with good general management of dairy calves and overall good colostrum quality

A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease – strategies for optimizing treatment outcome

Adherence describes how a patient follows a medical regime recommended by a healthcare provider. Poor treatment adherence represents a complex and challenging problem of international healthcare systems, as it has a substantial impact on clinical outcomes and patient safety and constitutes an important financial burden. Since it is one of the most common causes of treatment failure, it is extremely important for physicians to reliably distinguish between non‐adherence and non‐response. This systematic review aims to summarize the current literature on treatment adherence in dermatology, focusing on chronic inflammatory skin diseases such as psoriasis, atopic dermatitis and acne. A systematic literature search was performed using the PubMed Database, including articles from 2008 to 2018. Low treatment adherence is a multidimensional phenomenon defined by the interplay of numerous factors and should under no circumstances be considered as the patient's fault alone. Factors influencing treatment adherence in dermatology include patient characteristics and beliefs, treatment efficacy and duration, administration routes, disease chronicity and the disease itself. Moreover, the quality of the physician‐patient relationship including physician‐time available for the patient plays an important role. Understanding patients’ adherence patterns and the main drivers of non‐adherence creates opportunities to improve adherence in the future. Strategies to increase treatment adherence range from reminder programs to simplifying prescriptions or educational interventions. Absolute adherence to treatment may not be realistically achievable, but efforts need to be made to raise awareness in order to maximize adherence as far as possible

Patient and public involvement in cancer research: A scoping review.

Patient and public involvement (PPI) in research emphasizes the importance of doing research with, rather than for people with lived health/illness experience(s). The purpose of this scoping review is to investigate the breadth and depth of scientific literature on PPI in cancer research and to identify how is PPI applied and reported in cancer research. We searched MEDLINE, Embase, CINAHL, and PsycInfo up to March 2022. All titles/abstracts and full-text results were screened by two reviewers. Data were analyzed and are presented in both narrative and tabular format. We screened 22,009 titles/abstract, reviewed 375 full-text articles, of which 101 studies were included in this review. 66 papers applied PPI; 35 used co-design methodologies. PPI in cancer research in published research has increased steadily since 2015 and often includes those with a past diagnosis of cancer or relatives/informal caregivers. The most common applied methods were workshops or interviews. PPI was generally used at the level of consultation/advisor and occurred mainly in early stages of research. Costs related to PPI were mentioned in 25 papers and four papers described training provided for PPI. Results of our review demonstrate the nature and extent of PPI expansion in cancer research. Researchers and research organizations entering the fray of PPI should consider planning and reporting elements such as the stage, level, and role type of PPI, as well as methods and strategies put in place to assure diversity. Furthermore, a thorough evaluation of whether all these elements meet the stated PPI purpose will help to grasp its impact on research outcomes. Two patients participated in the stakeholder consultation as part of the scoping review methodology, contributed to the discussion on refining the results, and critically reviewed the manuscript. Both are co-authors of this manuscript

Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis.

To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. Systematic review and indirect-comparisons meta-analysis. Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of -0.77 (95% Credible Interval (CrI) -1.22 to -0.31), while massage (-0.78; -1.55 to -0.01), cognitive-behavioural therapy combined with physical activity (combined CBT, -0.72; -1.34 to -0.09), combined aerobic and resistance training (-0.67; -1.01 to -0.34), resistance training (-0.53; -1.02 to -0.03), aerobic (-0.53; -0.80 to -0.26) and yoga (-0.51; -1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (-0.68; -0.93 to -0.43). Combined aerobic and resistance training (-0.50; -0.66 to -0.34), combined CBT (-0.45; -0.70 to -0.21), Tai-Chi (-0.45; -0.84 to -0.06), CBT (-0.42; -0.58 to -0.25), resistance training (-0.35; -0.62 to -0.08) and aerobic (-0.33; -0.51 to -0.16) showed all small-to-moderate SMDs. Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF

Relationship between Resilience, Psychological Distress and Physical Activity in Cancer Patients: A Cross-Sectional Observation Study.

Psychological distress remains a major challenge in cancer care. The complexity of psychological symptoms in cancer patients requires multifaceted symptom management tailored to individual patient characteristics and active patient involvement. We assessed the relationship between resilience, psychological distress and physical activity in cancer patients to elucidate potential moderators of the identified relationships. A cross-sectional observational study to assess the prevalence of symptoms and supportive care needs of oncology patients undergoing chemotherapy, radiotherapy or chemo-radiation therapy in a tertiary oncology service. Resilience was assessed using the 10-item Connor-Davidson Resilience Scale (CD-RISC 10), social support was evaluated using the 12-item Multidimensional Scale of Perceived Social Support (MSPSS) and both psychological distress and activity level were measured using corresponding subscales of the Rotterdam Symptom Checklist (RSCL). Socio-demographic and medical data were extracted from patient medical records. Correlation analyses were performed and structural equation modeling was employed to assess the associations between resilience, psychological distress and activity level as well as selected socio-demographic variables. Data from 343 patients were included in the analysis. Our revised model demonstrated an acceptable fit to the data (χ2(163) = 313.76, p = .000, comparative fit index (CFI) = .942, Tucker-Lewis index (TLI) = .923, root mean square error of approximation (RMSEA) = .053, 90% CI [.044.062]). Resilience was negatively associated with psychological distress (β = -.59), and positively associated with activity level (β = .20). The relationship between resilience and psychological distress was moderated by age (β = -0.33) but not social support (β = .10, p = .12). Cancer patients with higher resilience, particularly older patients, experience lower psychological distress. Patients with higher resilience are physically more active. Evaluating levels of resilience in cancer patients then tailoring targeted interventions to facilitate resilience may help improve the effectiveness of psychological symptom management interventions

Experiences of people affected by cancer during the outbreak of the COVID-19 pandemic: an exploratory qualitative analysis of public online forums.

Studies focusing on patients with and survivors of cancer during the COVID-19 pandemic highlight unique psychological and behavioral challenges. These findings were obtained in surveys using self-report questionnaires with pre-specified response options that may not capture the broad range of experiences of individuals affected by cancer, including people with cancer and informal caregivers, in this unprecedented situation. Online forums produce a large amount of valuable first-hand user-generated content that can be used to better understand their day-to-day lives. This study, based on the analysis of narratives in cancer online forums, aims to describe and categorize the experiences of people affected by cancer during the outbreak of the COVID-19 pandemic. An inductive, descriptive, thematic approach was applied to publicly available cancer forums from Germany, the USA, the UK, and Ireland posted between mid-March and mid-April 2020. An analysis of the content of 230 main posts revealed three major themes: (1) concerns related to the impact of COVID-19 on cancer care, the risks and fears of getting infected, logistic issues, and economic impact; (2) adaptation challenges faced at the individual and societal level; and (3) the need for advice including information about COVID-19 and the (self-)management of cancer symptoms and treatment. Our qualitative description of the experiences of people affected by cancer during the COVID-19 pandemic outbreak can help to improve communication, education, and the development of supportive care strategies. Furthermore, the themes and subthemes identified could potentially inform item development for future self-report questionnaires