Informationsbedürfnisse von Prostatakrebspatienten: Große individuelle Unterschiede nach Diagnose eines lokalisierten Prostatakarzinoms

Zusammenfassung: Fragestellung: Hinsichtlich einer Patienteneinbindung bei der Therapieentscheidung sind Kenntnisse über die Informationsbedürfnisse von Patienten nach einer Prostatakarzinomdiagnose für behandelnde Fachleute wichtig. Die vorliegende Studie untersuchte Art und Umfang dieser Informationsbedürfnisse. Material und Methoden: In 4 urologischen Kliniken wurden Patienten 3-24Monate nach Diagnose eines lokalisierten Prostatakarzinoms mit einem erprobten Fragebogen befragt. Die 330 angeschriebenen Patienten retournierten 179Fragebögen, von denen 128 (39%) statistisch ausgewertet werden konnten. Ergebnisse: Es besteht ein umfangreicher Informationsbedarf bei individuell ausgeprägten Unterschieden zwischen Patienten. Jede Einzelne von 92 aufgeführten Fragen wurde von mindesten 18% der Patienten als "unentbehrlich"eingestuft. Die Befragten stuften durchschnittlich 50 von 92Fragen als "unentbehrlich" ein. Während ein Patient nur 4Fragen als "unentbehrlich" einschätzte, waren dies für einen anderen alle 92Fragen. Schlussfolgerungen: Angesichts der großen, individuell verschiedenen Informationsbedürfnisse ist bei der Therapieberatung die Identifikation der patientenspezifischen Bedürfnisse von zentraler Bedeutun

Evaluation of a prostate cancer e-health-tutorial

Hintergrund: Angesichts verschiedener Behandlungsoptionen ist die Information und Therapieentscheidung beim lokalisierten Prostatakarzinom eine Herausforderung. Die digitale Informationstechnologie bietet im Vergleich zu gedruckten Informationen mehr Möglichkeiten, die Information und die Patientenkommunikation bedarfsgerecht zu gestalten. Ziele: Zur Unterstützung der Therapieentscheidung und der Kommunikation mit Patienten ist in der deutschsprachigen Schweiz ein Online-Tutorial in einem systematischen Prozess entwickelt und in einer Pilotstudie getestet worden. In der Evaluation interessierten die Nutzerzufriedenheit, die Erfüllung der Informationsbedürfnisse, die Vorbereitung auf die Therapieentscheidung und deren subjektive Qualität. Material und Methoden: Die Plattform wurde in einem iterativen Prozess mittels Fokusgruppen mit Ärzten und Patienten auf der Grundlage von Informationen aus bestehenden Broschüren entwickelt. Für den Test der Plattform wurden in 8 urologischen Kliniken 87 Patienten zur Teilnahme eingeladen. Die 56 Nutzer wurden 4 Wochen nach dem Login und 3 Monate nach dem Therapieentscheid online befragt, 48 Nutzer füllten beide Befragungen aus. Eingesetzte Instrumente waren die Preparation for Decision Making Scale (PDMS), die Decisional Conflict Scale (DCS) und die Decisional Regret Scale (DRS). Ergebnisse und Diskussion: Die Nutzenden sind mit der Plattform sehr zufrieden und finden ihre Informationsbedürfnisse gut erfüllt. Sie zeigen 3 Monate nach dem Entscheid eine gute Vorbereitung auf die Entscheidung (MW PDMS 75, SD 23) und berichten über niedrigen Entscheidungskonflikt (MW DCS 9.6, SD 11) und kaum Bedauern über die Entscheidung (MW DRS 6.4, SD 9.6). Basierend auf diesen Erkenntnissen kann die Plattform zur weiteren Nutzung empfohlen werden.Background: Due to the multitude of therapy options the treatment decision after diagnosis of a localised prostate cancer is challenging. Compared to printed booklets, web based information technology offers more possibilities to tailor information to patients’ individual needs. Objectives: To support the decision making process as well as the communication with patients we developed an online tutorial in a systematic process in the German speaking part of Switzerland and then tested it in a pilot study. The study investigated users’ satisfaction, the coverage of information needs, the preparation for decision making and the subjective quality of the decision. Materials and methods: Based on already existing information material the online tutorial was developed in an iterative process using focus groups with patients and urologists. For the following evaluation in eight clinics a total of 87 patients were invited to access the platform and participate in the study. From these patients 56 used the tutorial and 48 answered both surveys (the first one 4 weeks after the first login and the second one 3 months after treatment decision). The surveys used the Preparation for Decision Making Scale (PDMS), the Decisional Conflict Scale (DCS), and the Decisional Regret Scale (DRS). Results and Conclusion: Satisfaction with the tutorial is very high among patients with newly diagnosed localized prostate cancer. Users find their information needs sufficiently covered. Three months after the decision they felt that they were well prepared for the decision making (Mean PDMS 75, SD 23), they had low decisional conflict (Mean DCS 9.6, SD 11) and almost no decisional regret (Mean DRS 6.4, SD 9.6). Based on these findings the further use of the tutorial can be recommended

Direct Type I IFN but Not MDA5/TLR3 Activation of Dendritic Cells Is Required for Maturation and Metabolic Shift to Glycolysis after Poly IC Stimulation

We thank the Rockefeller University Center for Clinical and Translational Science (UL1 TR000043 NCATS, NIH) for technical support

Wheat Pm4 resistance to powdery mildew is controlled by alternative splice variants encoding chimeric proteins

Crop breeding for resistance to pathogens largely relies on genes encoding receptors that confer race-specific immunity. Here, we report the identification of the wheat Pm4 race-specific resistance gene to powdery mildew. Pm4 encodes a putative chimeric protein of a serine/threonine kinase and multiple C2 domains and transmembrane regions, a unique domain architecture among known resistance proteins. Pm4 undergoes constitutive alternative splicing, generating two isoforms with different protein domain topologies that are both essential for resistance function. Both isoforms interact and localize to the endoplasmatic reticulum when co-expressed. Pm4 reveals additional diversity of immune receptor architecture to be explored for breeding and suggests an endoplasmatic reticulum-based molecular mechanism of Pm4-mediated race-specific resistance

Dendritic cell-specific delivery of Flt3L by coronavirus vectors secures induction of therapeutic antitumor immunity

Efficacy of antitumor vaccination depends to a large extent on antigen targeting to dendritic cells (DCs). Here, we assessed antitumor immunity induced by attenuated coronavirus vectors which exclusively target DCs in vivo and express either lymphocyte- or DC-activating cytokines in combination with a GFP-tagged model antigen. Tracking of in vivo transduced DCs revealed that vectors encoding for Fms-like tyrosine kinase 3 ligand (Flt3L) exhibited a higher capacity to induce DC maturation compared to vectors delivering IL-2 or IL-15. Moreover, Flt3L vectors more efficiently induced tumor-specific CD8(+) T cells, expanded the epitope repertoire, and provided both prophylactic and therapeutic tumor immunity. In contrast, IL-2- or IL-15-encoding vectors showed a substantially lower efficacy in CD8(+) T cell priming and failed to protect the host once tumors had been established. Thus, specific in vivo targeting of DCs with coronavirus vectors in conjunction with appropriate conditioning of the microenvironment through Flt3L represents an efficient strategy for the generation of therapeutic antitumor immunity

Bioimpedance-Derived Phase Angle and Mortality Among Older People.

BACKGROUND Phase angle measured by bioelectrical impedance analysis (BIA) may be a marker of health state. OBJECTIVE This historical cohort study of prospectively collected BIA measurements aims to investigate the link between phase angle and mortality in older people and evaluate whether a phase angle cutoff can be defined. DESIGN We included all adults aged ≥65 years who underwent a BIA measurement by the Nutriguard(®) device at the Geneva University Hospitals. We retrieved retrospectively the phase angle and comorbidities at the last BIA measurement and mortality until December 2012. We calculated phase angle standardized for sex, age, and body mass index (BMI), using reference values determined with the same brand of BIA device. Sex-specific and standardized phase angle were categorized into quartiles. The association of mortality with sex-specific or standardized phase angle was evaluated through univariate and multivariate Cox regression models, Kaplan-Meier curves, and receiver operating characteristic (ROC) curves. RESULTS We included 1307 (38% women) participants, among whom 628 (44% women) died. In a multivariate Cox regression model adjusted for comorbidities and setting of measurement (ambulatory vs. hospitalized), the protective effect against mortality increased progressively as the standardized phase angle quartile increased (HR 0.71 [95% CI 0.58, 0.86], 0.53 [95% CI 0.42, 0.67], and 0.32 [95% CI 0.23, 0.43]). The discriminative value of continuous standardized phase angle, assessed as the area under the ROC curve, was 0.72 (95%CI 0.70, 0.75). We could not define an acceptable phase angle cutoff for individual prediction of mortality (LK), based on sensibility and specificity values. CONCLUSIONS This study shows the association of phase angle and mortality in older patients, independent of age, sex, comorbidities, BMI categories, and setting of measurement

Association of mortality and phase angle measured by different bioelectrical impedance analysis (BIA) devices.

PURPOSE A high phase angle measured by the Nutriguard(®) bioelectrical impedance analysis device is associated with a reduced mortality risk in older people. This retrospective study aims to analyze whether this association persists with the other devices that have been used in our hospital. METHODS This study encompasses all people 65 yrs and older who underwent a phase angle measurement between 1990 and 2011 at the Geneva University Hospitals, with the RJL-101(®) (RJL Systems), Xitron 4000B(®) (Xitron Technologies), Eugedia(®) (Eugédia-Spengler) and Bio-Z(®) (Spengler). Diseases at the time of phase angle measurement were reported in the form of the Cumulative Illness Rating Scale. Date of death was retrieved until December 2012. Phase angle values were categorized into sex- and device-specific quartiles, where quartile 1 represents the lowest quartile and reference value. Cox regressions were performed to evaluate the association between phase angle quartiles and mortality. RESULTS We considered 1878 people (969 women), of whom 1151 had died. In univariate sex-specific Cox regressions, the death risk decreased progressively as the phase angle quartile measured by the Bio-Z(®) or RJL-101(®) increased. The HR (95% CI) in quartile 4 was 0.36 (0.26, 0.50) and 0.38 (0.29, 052) in women and men measured with the Bio-Z(®) (both p < 0.001), and 0.23 (0.14, 0.39) and 0.19 (0.10, 0.36) in women and men measured with the RJL-101(®) (both p < 0.001). The association between phase angle and mortality persisted when adjusted for age, body mass index or co-morbidities. The small number of deaths in people who underwent a measurement by Eugedia(®) (n = 93) or Xitron 4000B(®) (n = 56) did not allow performing multivariate Cox regressions. CONCLUSIONS Phase angle quartiles are associated with mortality in people aged ≥65 years when using the RJL-101(®) or Bio-Z device(®)