Der Alltag von Menschen mit COPD (Chronic Obstructive Pulmonary Disease)

In Europa ist COPD bereits die dritthäufigste Todesursache und die Prävalenz beträgt weltweit betrachtet ca. 5%. Allerdings existieren bisher nur wenige Studien, die sich mit dem subjektiven Erleben der körperlichen, psychischen und sozialen Belastungen der Erkrankten, sowie deren pflegende Angehörigen befassen. Außerdem gibt es bisher wenige Untersuchungen, welche die COPD spezifischen Bewältigungsstrategien der Kranken behandeln. Deshalb wurden für diese Diplomarbeit der derzeitige Wissensstand zu diesem Thema analysiert und die wichtigsten Literaturquellen zusammengefügt. Im ersten Teil setzt sich die Arbeit mit der Krankheitsdefinition, der Diagnose und der Klassifikation auseinander. Weiters werden die Epidemiologie, die Kosten für das Gesundheitssystem und die Risikofaktoren dargestellt. Zudem werden das Management, die Therapiemöglichkeiten, sowie die pneumologische Rehabilitation behandelt. Der zweite Abschnitt befasst sich mit den Stresstheorien, den Belastungen von chronisch Kranken und von pflegenden Familienmitgliedern. Außerdem wird der Krisenbegriff erläutert. Im dritten Teil werden die spezifischen Belastungen von COPD kranken Menschen dargestellt. Dabei wird auf die körperlichen Auswirkungen, nämlich Atemnot, verringerte körperliche Belastbarkeit, Gewichtsverlust und kognitive Beeinträchtigungen, sowie auf die bei Dyspnoe einhergehende Angst, eingegangen. Weiters werden die sozialen und sexuellen Beeinträchtigungen beschrieben. Zudem wird die Problematik der Krankheitsverschlechterungen behandelt. Am Ende des Kapitels werden häufig auftretende Begleiterkrankungen dargelegt. Die letzten zwei Teile der Arbeit befassen sich mit den Belastungen der pflegenden Angehörigen von Menschen mit der chronisch obstruktiven Lungenerkrankung und den spezifischen Bewältigungsstrategien der COPD Kranken. Die Intention dieser Diplomarbeit besteht darin, das Verständnis für Menschen mit der chronisch obstruktiven Lungenerkrankung (COPD) und deren pflegende Angehörigen zu erhöhen. Weiters soll dem Pflegepersonal Wissen über die speziellen Belastungen dieser Lungenkrankheit zur Verfügung gestellt werden, um Anregungen für eine Verbesserung der Pflege zu geben.In Europe COPD is the third leading cause of death and the worldwide prevalence is about 5%. However, at the moment there are only few studies dealing with the subjective experiences of the physical, psychological and social burden of those suffering and their caregivers. There is dearth literature about the specific coping strategies of COPD patients. Therefore, for this thesis, the current state of knowledge on this subject was analyzed and the most important literature was assembled. The first part of the thesis is dealing with the definition of this disease, the diagnosis and the classification. Moreover, the epidemiology, the costs for the health care system and the risk factors will be described. Furthermore, the management of the disease, the therapies and the pulmonary rehabilitation will be presented. The second section describes the theories of stress, the burden of people concerned with chronic diseases and the difficulties of caring family members to cope with it. Thus, the concept of crisis is explained. In the third part, the specific burden of people with COPD is presented. In this case, the physical effects, namely dyspnea, decreased exercise tolerance, weight loss and cognitive impairment, and the anxiety associated with the shortness of breath will be explained. The social and sexual problems will be described. At the end of this chapter the common comorbid diseases are presented. The following part is dealing with the burden of the caregiving people. The last section deals with the COPD-specific coping strategies. The intention of this thesis is to increase the understanding of people with chronic obstructive pulmonary disease (COPD) and their caregivers. Furthermore, knowledge about the special burdens of this lung disease should be provided to the nursing staff, to improve the quality of everyday care

A single-arm phase II Austrian/German multicenter trial on continuous daily sunitinib in primary glioblastoma at first recurrence (SURGE 01-07)

Background: Due to the redundancy of molecular pathways simultaneously involved in glioblastoma growth and angiogenesis, therapeutic approaches intervening at multiple levels seem particularly appealing. Methods: This prospective, multicenter, single-arm phase II trial was designed to evaluate the antitumor activity of sunitinib, an oral small-molecule inhibitor of several receptor tyrosine kinases, in patients with first recurrence of primary glioblastoma using a continuous once-daily dosing regimen. Patients received a starting dose of sunitinib 37.5 mg, followed by a maintenance dose between 12.5 mg and 50 mg depending on drug tolerability. The primary endpoint was a 6-month progression-free survival (PFS) rate. Secondary endpoints included median PFS, overall survival (OS), safety/toxicity, quality of life, and translational studies on the expression of sunitinib target molecules. Results: Forty participants were included in this study, and no objective responses were detected. PFS6 was 12.5%, median PFS 2.2 months, and median OS 9.2 months. Five participants (12.5%) showed prolonged stable disease ≥6 months with a median PFS of 16.0 months (range, 6.4–41.4 mo) and a median OS of 46.9 months (range, 21.2–49.2 mo) for this subgroup. c-KIT expression in vascular endothelial cells (n = 14 participants) was associated with improved PFS. The most common toxicities were fatigue/asthenia, mucositis/dermatitis, dysesthesias, gastrointestinal symptoms, cognitive impairment, leukoctopenia, and thrombocytopenia. Two participants (5%) terminated treatment due to toxicity. Conclusion: Continuous daily sunitinib showed minimal antiglioblastoma activity and substantial toxicity when given at higher doses. High endothelial c-KIT expression may define a subgroup of patients who will benefit from sunitinib treatment by achieving prolonged PFS

The pro-migratory and pro-invasive role of the procoagulant tissue factor in malignant gliomas

During the infiltration process, glioma cells are known to migrate along preexisting anatomical structures such as blood vessels, axonal fiber tracts and the subependymal space, thereby widely invading surrounding CNS tissue. This phenomenon represents a major obstacle for the clinical treatment of these tumors. Several extracellular key factors and intracellular signaling pathways have been previously linked to the highly aggressive, invasive phenotype observed in malignant gliomas. The glioblastoma (GBM), which is the most malignant form of these tumors, is histologically characterized by areas of tumor necroses and pseudopalisading cells, the latter likely representing tumor cells actively migrating away from the hypoxic- ischemic core of the tumor. It is believed that intravascular thromboses play a major role in the emergence of hypoxia and intratumoral necroses in GBMs. One of the most highly upregulated prothrombotic factor in malignant gliomas is tissue factor (TF), a 47 kDa type I transmembrane protein belonging to the cytokine receptor superfamily. In a recent study, we provided evidence that TF/FVIIa signaling via the protease-activated receptor 2 (PAR-2) promotes cell growth, migration and invasion of glioma cells. In this Commentary & View, we outline the key molecular players involved in migration and invasion of gliomas, highlight the potential role of TF for the pro-migratory and pro-invasive phenotype of these tumors and discuss the underlying mechanisms on the cellular level and in the tumor microenvironment