Case Management

Durch den immer weitere Ausmaße annehmenden multidisziplinären Behandlungspfad insbesondere bei langwierigen Krankheiten, darunter vor allem Krebserkrankungen, ist es nötig, durch Umstrukturierung und neue Konzepte ein neues System zur Optimierung sowohl der anfallenden Kosten, als auch der Betreuung der Patientinnen, in psychischer wie auch in physischer Hinsicht, zu entwickeln. In diesem Sinne wurde ein Versuch zur Verbesserung in der Behandlung von Brustkrebspatientinnen 2003 in Augsburg in Form des Case Managements gestartet. In einer Fall-Kontroll-Studie wurde ein Vergleich zwischen der psychischen Lebensqualität von Patientinnen, welche dem alten Behandlungspfad folgten, und denen, welche nach dem System des Case Managements betreut wurden, gezogen. Die durchgeführte Studie zeigt, dass es erste positive Zusammenhänge zwischen der neuen Betreuungsform und der Lebensqualität der Patientinnen im Vergleich zu den alten Betreuungsmethoden gibt

Toxicity Analysis in the ADEBAR Trial: Sequential Anthracycline-Taxane Therapy Compared with FEC120 for the Adjuvant Treatment of High-Risk Breast Cancer

Background: Data from meta-analyses have shown taxane-containing therapies to be superior to anthracycline-based treatments for high-risk breast cancer. Patients and Methods: The ADEBAR trial was a multicenter phase Ill trial in which patients with lymph node-positive breast cancer were prospectively randomized for either sequential anthracycline-taxane or FEC120 therapy. Patients received 4x epirubicin (90 mg/m(2)) and cyclophosphamide (600 mg/m(2)) every 3 weeks (q3w), followed by 4x docetaxel (100 mg/m(2)) q3w (EC-Doc arm), or 6x epirubicin (60 mg/m(2)) and 5-fluorouracil (500 mg/m(2)) on days 1 and 8 and cyclophosphamide (75 mg/m(2)) on days 1-14, q4w (FEC arm). We compared both arms with respect to toxicity and feasibility. Results: Hematological toxicity was found significantly more often in the FEC arm. Febrile neutropenia was seen in 11.3% of patients in the FEC arm and in 8.4% of patients in the EC-Doc arm (p = 0.027). Non-hematological side effects of grade 3/4 were rarely seen in either arm. Therapy was terminated due to toxicity in 3.7% of the patients in the EC-Doc arm and in 8.0% of the patients in the FEC arm (p = 0.0009). Conclusion: The sequential anthracycline-taxane regimen is a well-tolerated and feasible alternative to FEC120 therapy

Fetal head moulding: finite element analysis of a fetal skull subjected to uterine pressures during the first stage of labour

Fetal head moulding is a phenomenon which may contribute to satisfactory progress during delivery as it allows the fetal head to accommodate to the geometry of the passage. In contrast, excessive head moulding may result in cranial birth injuries and thus affect the infant shortly or even long after birth. One group of researchers in the past investigated the biomechanics of fetal head moulding from an engineering point of view and limited themselves to a static, linear model of the parietal bones. In this paper, we present a non-linear model of the deformation of a complete fetal skull, when subjected to pressures exerted by the cervix, during the first stage of labour. The design of the model involves four main steps: shape recovery of the fetal skull, the generation of a valid and compatible mesh for finite element analysis (FEA), the specification of a physical model and the analysis of deformation. Results of the analysis show good agreement with those obtained from clinical experiments on the quantitative assessment of fetal head moulding. The model also displays shapes after moulding which have been reported in previous studies and which are generally known in the obstetric and paediatric communities