How Much Information and Participation Do Patients with Inflammatory Rheumatic Diseases Prefer in Interaction with Physicians? Results of a Participatory Research Project.

OBJECTIVE: Patient preferences for information and participation in medical decision-making are important prerequisites to realize a shared decision between patients and physicians. This paper aims at exploring these preferences in German patients with inflammatory rheumatic diseases and at identifying relevant determinants of these preferences. METHODS: In a cross-sectional survey, adult patients with rheumatoid arthritis (RA), spondyloarthritis (SA) or different connective tissue diseases (CTS) filled out a questionnaire. Data were collected via a written questionnaire (1) sent to members of a regional self-help group or (2) handed out to patients at their rheumatologist's appointment, and (3) via an online questionnaire available nationwide. Measurements included information and participation preferences (Autonomy Preference Index; API: 0-100), as well as health-related and sociodemographic variables. Analyses included ANOVAs (group differences) and multiple regression analyses (determinants of preferences). To ensure the analysis was patient-centered we involved a trained representative of the German League Against Rheumatism as a research partner. RESULTS: 1616 patients returned questionnaires [44% response, 79% female, mean age 54 years, diagnoses 63% RA, 28% SA, 19% CTS]. Participants reported a concurring major preference for information but vastly different preferences for participation. A greater preference for participation was associated with female sex, younger age, higher household income, and self-help group membership. Conversely, a lower preference for participation was linked to blue-collar workers, retirement, higher confidence in the rheumatologist, and poorer health literacy. CONCLUSION: Whereas patients consistently welcome comprehensive information about their disease and its different treatment options, not all patients wish to be involved in therapeutic decisions. Especially older patients with lower education status and lower health literacy, but higher confidence in their rheumatologist tend to leave the decisions rather to the physician. Different preferences should be considered in the doctor-patient communication.

The effects of ethanol on CNS development in the chick embryo.

Human and animal studies show that the central nervous system (CNS) is particularly vulnerable to developmental exposure to alcohol across all stages of development. New critical periods of ethanol sensitivity continue to be defined. The aim of this study was to further examine the stage-specific effects of ethanol on CNS development using a relatively simple programme of neuronal migration and differentiation, the chick embryo spinal cord, and treating at the immediate post-neurulation stage. Embryos (HH-stage 10-12) were explanted into shell-less culture and treated with ethanol (20 microl/40%) or saline (20 microl). At 6,12, 24 and 48 h post-treatment specimens were processed for resin histology. In addition, levels of cell death were analysed using Lysotracker Red, neural crest cell migration patterns were examined using HNK-1 staining and effects on DNA synthesis were evaluated on autoradiographs prepared 1h after exposure to 3H-TdR. This treatment protocol produced significant growth retardation in ethanol specimens examined at 48 h post-treatment. This effect was shown to involve increased levels of cell death, perturbation of DNA synthesis and an abnormal translocation and subsequent loss of cells into the neural tube lumen. No gross malformations were observed. We conclude that these results further highlight the stage-specific effects of ethanol on neurodevelopment.

Orthopaedic issues in sports for persons with haemophilia.

Persons with haemophilia should not feel limited in their ability to participate in sports. After consultation with a physician or other health-care provider and with a proper understanding of the risks involved and the strategies for managing these risks, patients with haemophilia can - and should - enjoy physical activities. We have analysed numerous reports of sports injury statistics and used them to rank a variety of sports according to their degree of injury risk. In addition, we have developed a brief orthopaedic examination and a five-item fitness check that evaluates the level of physical fitness of patients with haemophilia. Using these tools, we can appropriately recommend specific sports activities best suited for each patient. In addition, we recommend that patients who regularly participate in sports maintain adequate levels of clotting factor through the use of regular prophylaxis. With proper physical evaluation and preparation, patients with haemophilia can realize the physical and emotional benefits of participation in sports.

Safety and efficacy of a novel cannabinoid chemotherapeutic, KM-233, for the treatment of high-grade glioma.

OBJECTIVE: To test in vitro and in vivo the safety and efficacy of a novel chemotherapeutic agent, KM-233, for the treatment of glioma. METHODS: In vitro cell cytotoxicity assays were used to measure and compare the cytotoxic effects of KM-233, Delta(8)-tetrahydrocannabinol (THC), and bis-chloroethyl-nitrosurea (BCNU) against human U87 glioma cells. An organotypic brain slice culture model was used for safety and toxicity studies. A human glioma-SCID mouse side-pocket tumor model was used to test in vivo the safety and efficacy of KM-233 with intratumoral and intra-peritoneal administration. RESULTS: KM-233 is a classical cannabinoid with good blood brain barrier penetration that possesses a selective affinity for the CB2 receptors relative to THC. KM-233 was as efficacious in its cytotoxicity against human U87 glioma as Delta(8)-tetrahydrocannabinol, and superior to the commonly used anti-glioma chemotherapeutic agent, BCNU. The cytotoxic effects of KM-233 against human glioma cells in vitro occur as early as two hours after administration, and dosing of KM-233 can be cycled without compromising cytotoxic efficacy and while improving safety. Cyclical dosing of KM-233 to treat U87 glioma in a SCID mouse xenograft side pocket model was effective at reducing the tumor burden with both systemic and intratumoral administration. CONCLUSION: These studies provide both in vitro and in vivo evidence that KM-233 shows promising efficacy against human glioma cell lines in both in vitro and in vivo studies, minimal toxicity to healthy cultured brain tissue, and should be considered for definitive preclinical development in animal models of glioma.