Wissenschaftliche Evaluation eines tagesklinischen Modell-Versorgungsprogrammes mit Schwerpunkt Mind-Body-Medizin bei Patienten mit Krebserkrankungen

Abstrakt Einleitung: Krebserkrankungen verursachen häufig psychosoziale und körperliche Beschwerden. Etwa 50–60 % aller Krebspatienten wünschen sich nach aktuellen Erhebungen den Einbezug naturheilkundlicher Verfahren in ihre Therapie. Das sich in Essen und Berlin etablierte Modellprogramm der naturheilkundlichen Onkologie, bezieht die jeweils wissenschaftlichen Einzelelemente der Mind-Body Medizin und Ordnungstherapie mit gesundheitsfördernden Lebensstilmodifikationen, Achtsamkeit, Bewegungstherapie, Kneipp-Therapie und Ernährungstherapie, sowie zusätzlichen Aspekten aus naturheilkundlichen Verfahren ein. Es umfasst ein 12-tägiges Intervallprogramm über drei Monate mit 77 Gruppentherapiestunden sowie 100 häuslichen Übungsstunden. Ziel der Arbeit ist die Evaluierung der Effekte und die Wirkung auf psychologische/soziale Funktionen (v.a. Lebensqualität) durch einen Prä/Post- und Gruppenvergleich mittels einer prospektiven Beobachtungsstudie (Kohortenstudie) und einem nicht-randomisierten Wartegruppen-Vergleich. Methodik: Es wurden von Januar 2013 - Juni 2014 alle an einer Teilnahme interessierten onkologischen Patienten mittels prospektiver Beobachtungsstudie erfasst. Die Gruppenbildung erfolgte durch eine unbeeinflusste Warteliste (Cut-off der Wartedauer: 4 Wochen). Die Datenerhebungen erfolgten zu Beginn, kurz nach Beendigung der dreimonatigen Tagesklinik, sowie drei Monate später. Die Wartegruppe wurde zusätzlich bei Aufnahme in die Warteliste befragt. Alle Outcomes wurden mittels validierten Fragebögen erfasst: Die Entwicklung der Lebensqualität mit dem Functional Assessment of Cancer Therapy (FACT-G/B/C) und 5- Well-Being-Index (WHO-5), Fatigue mit dem Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), Angst und Depressivität mit der Hospital Anxiety and Depression Scale (HADS) und die Erfassung des subjektiven Wohlbefindens mit dem Fragebogen zur aktuellen Stimmungslage (ASTS). Zusätzlich wurden körperliche Aktivitäten und die Nutzung von Entspannungsverfahren registriert. Ergebnisse: Insgesamt wurden 100 Patienten gescreent, 86 Personen (83% Frauen, mittleres Alter 53,7 ± 9,7 Jahre, 49% Brustkrebs-Patienten, 7% Kolorektaltumor-Patienten, 44% Patienten mit anderen Tumorerkrankungen) wurden in die Studie eingeschlossen. Nach Ausrechnung der Drop Outs (n=6) verblieben für die per Protokoll Analyse n=46 in der Interventionsgruppe und n=20 in der Wartegruppe. Im Vergleich mit der Wartegruppe zeigte die Interventionsgruppe signifikant positive Veränderungen in verschiedenen Parametern nach Teilnahme an der Tagesklinik (Verbesserung der Lebensqualität, Ängstlichkeit/Depression und Fatigue). Die Wartegruppe verblieb dagegen auf ihrem Ausgangswert bzw. teilweise darunter. Bei Betrachtung der Dynamik während der Intervention wurde ein größerer Benefit bei der Wartegruppe gesehen. Positive Resultate aus der Follow-Up Befragung wurden für alle Patienten beschrieben. Es ergab sich eine gute Gesamtwirkung und eine >97%ige Empfehlung des beschriebenen Versorgungsprogrammes. Schlussfolgerung: In dieser Outcome-Erhebung zeigte sich ein signifikanter Effekt der Teilnahme an einem multimodalen tagesklinischen, naturheilkundlichen Behandlungsprogramm im Intragruppenvergleich und im nicht-randomisierten Kontrollgruppenvergleich. Ein Nutzen des beobachteten Programmes, erscheint für Patienten mit onkologischen Erkrankungen als ergänzende Therapie wahrscheinlich. Weitere randomisiert-kontrollierte Studien zur genauen Evaluation der Wirksamkeit sind zu empfehlen.Introduction: Cancer often causes psychosocial and physical problems. According to current surveys, approximately 50-60% of all cancer patients would like to include methods of the “Integrative Medicine” in their therapy. The model program of “Integrative Oncology” treatment is established in Germany and focuses on evidence-based elements of mind-body medicine as well as the health-supporting lifestyle modifications, mindfulness etc. in a 12 day interval program over three months. The program includes 77 group therapy sessions per month and 100 home practice hours. The aim of this program is to evaluate the effect and the impact on psychological/social functions. This is achieved through a pre-/post-group comparison by a prospective observational study (cohort study) and a non-randomized waiting group comparison. Methods: From January 2013 until June 2014, all oncologic patients, who were interested in participating in the study, were enrolled in an observing study. The groups were formed by an uninfluenced waiting list. The data was collected at the beginning of the study, after completing a three months period of a day clinic and again three months later. The waiting group were also assessed upon admission in the waiting list. All outcomes were recorded using validated questionnaires: (FACT-G/B/C), (WHO-5), (FACIT-F), (HADS) and (ASTS). In addition, physical activity and use of relaxation procedures were tracked. Results: A total of 100 patients were screened, 86 people (83% women, age 53.7 ± 9.7 years, 49% breast cancer patients, 7% colorectal cancer patients, 44% patients with other tumor diseases) were included in the study. N=46 remained for per protocol analysis in the intervention group and n=20 in the waiting group. In comparison with the patients of the waiting group the intervention group showed significant positive changes in several parameters after participation in the day clinic (e. g. quality of life, anxiety/depression, fatigue), while the waiting group remained at its level or deteriorated. Considering the changes in the course of the intervention, positive results from the follow-up survey were reported for all participants of the day clinic. The overall effect was good and a 97% recommendation of the day care clinic program. Conclusion: In this study a significant effect was shown in participants who attended a multimodal daytime clinic program in comparison to a non-randomized control group. A benefit of this program for patients with oncological diseases as complementary therapy seems likely. Further randomized controlled trials for accurate evaluation of effectiveness are recommended

Methylene blue as treatment for vasoplegic shock in severe metformin overdose:A case report

Introduction: Severe metformin overdose can result in life-threatening conditions such as metabolic acidosis with hyperlactatemia and vasoplegic shock. Current treatment guidelines recommend hemodialysis and supportive care. However, this case report presents the use of methylene blue as an additional treatment for severe metformin overdose-induced vasoplegic shock, which is not commonly described in the literature or guidelines. Case report: A 55-year-old woman presented to the emergency department after ingesting 82.5 g of metformin, resulting in severe metabolic acidosis with hyperlactatemia and refractory vasoplegic shock. Despite continuous hemodialysis and high levels of noradrenalin and vasopressin, the shock persisted. Methylene blue was administered, leading to an immediate and persistent reduction in the noradrenalin dose and rapid shock resolution. Discussion: This case illustrates the potential use of methylene blue in the treatment of severe metformin overdose. The mechanism for metformin-induced vasoplegia is likely mediated by nitric oxide (NO). Methylene blue has been used to treat NO-mediated vasoplegia in other conditions, such as sepsis and poisoning with beta-blockers and calcium channel blockers, but it is rarely described in metformin toxicity. Methylene blue has a rapid onset of action, with only a few mild side effects. This case report emphasizes the need for clinicians to consider methylene blue as a potential treatment option in cases of refractory vasoplegic shock due to severe metformin overdose.</p

Pharmacokinetics of amphotericin B after accidental overdose in an adult critically ill patient treated with plasmapheresis: a case report and review of literature

Amphotericin B is a broad-spectrum antifungal agent that is used in the treatment of systemic fungal infections. We describe the case of a 62-year-old female patient with recent aneurysmal subarachnoid hemorrhage who was treated for suspected ventriculitis and a fungal coinfection. Instead of liposomal amphotericin B (L-AmB), 465 mg (5 mg/kg) amphotericin B deoxycholate (DOC) was inadvertently administered, leading to refractory shock with multiple organ failure and requiring mechanical ventilation. Since an overdose of amphotericin B can lead to fatal consequences and has a half-life of 15 days, plasmapheresis was started. The serum concentration decreased from 1.32 µg/mL to 0.62 µg/mL before plasmapheresis, demonstrating a mean half-life of 49 hours. After two plasmapheresis sessions, the serum concentration further dropped to 0.26 µg/mL, demonstrating a mean half-life of 17 hours. In contrast, the third plasmapheresis session had no effect on serum concentration. The patient made a full recovery, potentially facilitated by enhanced amphotericin B elimination through plasmapheresis. Positive outcomes were previously reported in two adult patients treated with plasmapheresis. However, other reports without plasmapheresis described fatal outcomes in adult patients, albeit with a twofold overdose compared to the two patients successfully treated with plasmapheresis. Moreover, plasmapheresis itself carries risks such as hypocalcemia, metabolic alkalosis, and coagulation deficits. Consequently, the role of plasmapheresis in amphotericin B overdose is still debated

Anti-tumour compounds illudin S and Irofulven induce DNA lesions ignored by global repair and exclusively processed by transcription- and replication-coupled repair pathways.

Illudin S is a natural sesquiterpene drug with strong anti-tumour activity. Inside cells, unstable active metabolites of illudin cause the formation of as yet poorly characterised DNA lesions. In order to identify factors involved in their repair, we have performed a detailed genetic survey of repair-defective mutants for responses to the drug. We show that 90% of illudin's lethal effects in human fibroblasts can be prevented by an active nucleotide excision repair (NER) system. Core NER enzymes XPA, XPF, XPG, and TFIIH are essential for recovery. However, the presence of global NER initiators XPC, HR23A/HR23B and XPE is not required, whereas survival, repair and recovery from transcription inhibition critically depend on CSA, CSB and UVS, the factors specific for transcription-coupled NER. Base excision repair and non-homologous end-joining of DNA breaks do not play a major role in the processing of illudin lesions. However, active RAD18 is required for optimal cell survival, indicating that the lesions also block replication forks, eliciting post-replication-repair-like responses. However, the translesion-polymerase DNA pol eta is not involved. We conclude that illudin-induced lesions are exceptional in that they appear to be ignored by all of the known global repair systems, and can only be repaired when trapped in stalled replication or transcription complexes. We show that the semisynthetic illudin derivative hydroxymethylacylfulvene (HMAF, Irofulven), currently under clinical trial for anti-tumour therapy, acts via the same mechanism

Psychiatry, subjectivity and emotion - deepening the medical model

Morale among psychiatrists continues to be seriously challenged in the face of recruitment difficulties, unfilled posts, diagnostic controversies, service reconfigurations and public criticism of psychiatric care, in addition to other difficulties. In this article, we argue that the positivist paradigm that continues to dominate British psychiatry has led to an undervaluing of subjectivity and of the role of emotions within psychiatric training and practice. Reintegrating the subjective perspective and promoting emotional awareness and reflection may go some way towards restoring faith in the psychiatric specialty

Out of the wave: The meaning of suffering and relief from suffering as described in autobiographies by survivors of the 2004 Indian Ocean tsunami

The aim of this study was to explore the meaning of suffering and relief from suffering as described in autobiographies by tourists who experienced the tsunami on 26 December 2004 and lost loved ones. A lifeworld approach, inspired by the French philosopher Merleau-Ponty's phenomenology of perception, was chosen for the theoretical framework. This catastrophe totally changed the survivors' world within a moment. In this new world, there were three main phases: the power of remaining focused, a life of despair, and the unbearable becoming bearable. Life turns into a matter of making the unbearable bearable. Such challenging experiences are discussed in terms of the philosophy of Weil, Jaspers, and Merleau-Ponty. The survivors of the tsunami catastrophe were facing a boundary situation and “le malheur,” the unthinkable misfortune. Even at this lowest level of misfortune, joy is possible to experience. This is part of the survivors' ambivalent experiences of their lifeworld. In this world of the uttermost despair there are also rays of hope, joy, and new life possibilities

SNAPSHOT USA 2019 : a coordinated national camera trap survey of the United States

This article is protected by copyright. All rights reserved.With the accelerating pace of global change, it is imperative that we obtain rapid inventories of the status and distribution of wildlife for ecological inferences and conservation planning. To address this challenge, we launched the SNAPSHOT USA project, a collaborative survey of terrestrial wildlife populations using camera traps across the United States. For our first annual survey, we compiled data across all 50 states during a 14-week period (17 August - 24 November of 2019). We sampled wildlife at 1509 camera trap sites from 110 camera trap arrays covering 12 different ecoregions across four development zones. This effort resulted in 166,036 unique detections of 83 species of mammals and 17 species of birds. All images were processed through the Smithsonian's eMammal camera trap data repository and included an expert review phase to ensure taxonomic accuracy of data, resulting in each picture being reviewed at least twice. The results represent a timely and standardized camera trap survey of the USA. All of the 2019 survey data are made available herein. We are currently repeating surveys in fall 2020, opening up the opportunity to other institutions and cooperators to expand coverage of all the urban-wild gradients and ecophysiographic regions of the country. Future data will be available as the database is updated at eMammal.si.edu/snapshot-usa, as well as future data paper submissions. These data will be useful for local and macroecological research including the examination of community assembly, effects of environmental and anthropogenic landscape variables, effects of fragmentation and extinction debt dynamics, as well as species-specific population dynamics and conservation action plans. There are no copyright restrictions; please cite this paper when using the data for publication.Publisher PDFPeer reviewe

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery