Effects of dignity therapy on psychological distress and wellbeing of palliative care patients and family caregivers – a randomized controlled study

Background This study extended the original Dignity Therapy (DT) intervention by including partners and family caregivers (FCs) of terminally-ill cancer patients with the overall aim of evaluating whether DT can mitigate distress in both patients nearing the end of life and their FCs. Methods In this multicenter, randomized controlled trial (RCT), a total of 68 patients with life expectancy < 6 months and clinically-relevant stress levels (Hospital Anxiety Depression total score; HADS$_{tot}$ ≥ 8) including their FCs were randomly assigned to DT, DT + (including their FCs), or standard palliative care (SPC) in a 1:1:1 ratio. Study participants were asked to complete a set of questionnaires pre- and post-intervention. Results The coalesced group (DT and DT +) revealed a significant increase in patients’ perceived quality of life (FACIT-Pal-14) following the intervention (mean difference 6.15, SD = 1.86, p < 0.01). We found a statistically significant group-by-time interaction effect: while the HADS$_{tot}$ of patients in the intervention group remained stable over the pre-post period, the control group’s HADS$_{tot}$ increased (F = 4.33, df = 1, 82.9; p < 0.05), indicating a protective effect of DT. Most patients and their FCs found DT useful and would recommend it to other individuals in their situation. Conclusions The DT intervention has been well-received and shows the potential to increase HRQoL and prevent further mental health deterioration, illness burden and suffering in terminally-ill patients. The DT intervention holds the potential to serve as a valuable tool for facilitating end-of-life conversations among terminally-ill patients and their FCs. However, the implementation of DT within the framework of a RCT in a palliative care setting poses significant challenges. We suggest a slightly modified and less resource-intensive version of DT that is to provide the DT inventory to FCs of terminally-ill patients, empowering them to ask the questions that matter most to them over their loved one’s final days. Trial registration This study was registered with Clinical Trial Registry (ClinicalTrials.gov -Protocol Record NCT02646527; date of registration: 04/01/2016). The CONSORT 2010 guidelines were used for properly reporting how the randomized trial was conducted

Roadmap Tiefe Geothermie für Deutschland : Handlungsempfehlungen für Politik, Wirtschaft und Wissenschaft für eine erfolgreiche Wärmewende

Strategiepapier von sechs Einrichtungen der Fraunhofer-Gesellschaft und der Helmholtz-Gemeinschaf

International Olympic Committee consensus statement on pain management in elite athletes

Pain is a common problem among elite athletes and is frequently associated with sport injury. Both pain and injury interfere with the performance of elite athletes. There are currently no evidence-based or consensus-based guidelines for the management of pain in elite athletes. Typically, pain management consists of the provision of analgesics, rest and physical therapy. More appropriately, a treatment strategy should address all contributors to pain including underlying pathophysiology, biomechanical abnormalities and psychosocial issues, and should employ therapies providing optimal benefit and minimal harm. To advance the development of a more standardised, evidence-informed approach to pain management in elite athletes, an IOC Consensus Group critically evaluated the current state of the science and practice of pain management in sport and prepared recommendations for a more unified approach to this important topic

Metabolische Regulation und Rekonstruktion bei Desulfobacterium autotrophicum

:i: Desulfobacterium autotrophicum :/i: is a marine sulfate-reducing bacterium, which is metabolically quite versatile. Here the it was tried to investigate metabolic regulation using a physiological, proteomic and RNA based methods. The investigations were focussed on cold-adaption, alcohol metabolism and the terminal oxidation of substrates

Metabolic reconstruction and regulation in Desulfobacterium autotrophicum

:i: Desulfobacterium autotrophicum :/i: is a marine sulfate-reducing bacterium, which is metabolically quite versatile. Here the it was tried to investigate metabolic regulation using a physiological, proteomic and RNA based methods. The investigations were focussed on cold-adaption, alcohol metabolism and the terminal oxidation of substrates

Physiological response to temperature changes of the marine, sulphate-reducing bacterium Desulfobacterium autotrophicum

Abstract The physiological response of bacteria to temperature is critical for the regulation of biogeochemical processes on daily, seasonal, and inter-annual time scales. We investigated the temperature response of the marine sulfate-reducing bacterium Desulfobacterium autotrophicum strain HRM2. Growth experiments in a temperature gradient block demonstrated that D. autotrophicum is psychrotolerant and grows between 0 and 31 ‡C. The normal range of temperature for growth is between 4 and 29 ‡C. The physiological response to temperature changes was studied with three sets of cells that were acclimated at 4, 10, and 28 ‡C, respectively. Sulfate reduction rates were determined in the temperature gradient block with short-term incubations to minimize growth. The rates were similar at the 4 and 10 ‡C acclimation temperature, and exhibited an enhanced response at 28 ‡C. At every acclimation temperature, sulfate reduction rates increased 20-fold from 31.7 to 41 ‡C. The relative proportion of cellular unsaturated fatty acids (e.g. cis16:1) and short-chain fatty acids increased when cells were grown at 4 ‡C compared to 28 ‡C. The proteome of D. autotrophicum strain HRM2 was studied by two-dimensional gel electrophoresis with soluble extracts of cells grown at the three respective acclimation temperatures. Protein patterns were similar with the exception of two proteins showing 5^10-fold lower abundance in the 4 ‡C culture compared to the 28 ‡C culture. In general, D. autotrophicum strain HRM2 responded to low temperatures by reduced metabolic activity rather than by pronounced de novo synthesis of specifically adapted enzymes. Such a strategy agrees well with in situ activities measured in field studies and may reflect a common physiological principle of psychrotolerant marine sulfate-reducing bacteria.

Combination treatment with an ETA‐receptor blocker and an ACE inhibitor is not superior to the respective monotherapies in attenuating chronic transplant nephropathy in a ‘Fisher‐to‐Lewis' rat model

Background. Specific endothelin A (ETA)‐receptor blockade and ACE inhibition attenuate chronic transplant nephropathy (CTN) in the ‘Fisher‐to‐Lewis' rat model. It is unknown (i) which of both pharmacological interventions attenuates CTN more effectively and (ii) whether combination therapy exerts additive nephroprotection. Methods. We compared (i) the effects of specific ETA‐receptor blockade with LU 302146 (30 mg/kg bw/day) and ACE inhibition with trandolapril (0.3 mg/kg bw/day) and (ii) the effect of a combination therapy of both drugs on the development of CTN. Kidneys of Fisher rats were orthotopically grafted to Lewis rats. Untreated ‘Fisher‐to‐Lewis' allografts served as controls (TX). All animals received low‐dose cyclosporin A (1.5 mg/kg body weight) for 10 days post‐transplant to inhibit early acute rejection episodes. The duration of the experiment was 36 weeks. Blood pressure (BP) was measured every other week by tail plethysmography. Indices of glomerulosclerosis (GS), tubulointerstitial and vascular damage, number of glomeruli, total glomerular volume and mean glomerular volume were measured using morphometric and stereological techniques, respectively. Albuminuria, blood chemistry and haematology were measured at the end of the experiment. Results. LU 302146 did not affect systolic BP. In contrast, trandolapril and combination treatment significantly reduced systolic BP. Histological signs of CTN were almost completely prevented by LU 302146 and trandolapril as compared to TX, e.g. GS=0.8±0.08 and 0.9±0.20 vs 1.8±0.21* (arbitrary unit; *P<0.001 vs treated groups). Allograft weight was significantly lower in treated vs TX animals. Trandolapril and combination therapy, but not LU 302146 alone, abrogated glomerular hypertrophy, i.e. mean glomerular volume: TX 2.22±0.43, trandolapril 1.61±0.38**, LU 302146 2.22±0.11, trandolapril+LU 302146 1.78±0.28* (μm3; *P<0.05 vs control and LU 302146, **P<0.01 vs control and LU 302146). Albuminuria was lower in treated compared to TX animals. Combination therapy did not confer additional benefit compared to the respective monotherapies. Conclusions. We conclude that ETA‐receptor blockade abrogates GS, tubulointerstitial and vascular damage in the ‘Fisher‐to‐Lewis' model of CTN to a similar extent as ACE inhibition. However, only ACE inhibition inhibits glomerular hypertrophy. In contrast to ACE inhibition, the effect of ETA‐receptor blockade is independent of BP. This finding is consistent with the notion that ETA‐receptor mediated events play a partly BP‐independent role in the genesis of CTN. Combination therapy exerts no additive nephroprotectio