[Level of Development of Clinical Ethics Consultation in Psychiatry - Results of a Survey Among Psychiatric Acute Clinics and Forensic Psychiatric Hospitals]. / Entwicklungsstand von klinischer Ethikberatung in der Psychiatrie.

OBJECTIVE: The aim of this article is to assess the level of development of clinical ethics consultation in psychiatric institutions in North Rhine-Westphalia. METHODS: Survey among medical directors, directors of nursing and administrative directors of all psychiatric acute clinics and forensic psychiatric hospitals in North Rhine-Westphalia. RESULTS: 113 persons working in psychiatric acute clinics responded (response rate: 48 %) and 13 persons working in forensic psychiatric hospitals (response rate 62 %). We received at least one response from 89 % of all psychiatric acute clinics and from 100 % of all forensic psychiatric hospitals. 92 % of the responding psychiatric acute clinics and 29 % of the responding forensic psychiatric hospitals have already implemented clinical ethics consultation. CONCLUSION: Clinical ethics consultation is more widespread in psychiatric institutions than was hitherto assumed. Future medical ethics research should therefore give greater attention to the methodology and the quality of clinical ethics consultation in psychiatric practice.

Utilizing technology for longitudinal communication with homeless youth.

The current study investigated forms of technology (phone calls, texts, email and Facebook) for maintaining contact with homeless youth over baseline, 1-week, 6-week, and 3-month follow-up interviews. The study combined quantitative tracking of youths' response patterns and open-ended interviews regarding youths' preferred methods of communication. Results indicate that maintaining communication with homeless youth requires persistence, including frequent contact attempts over several days. Cell phone contacts (calls or texts) were most successful in communicating with youth, with e-mail and Facebook messaging useful when phones were lost or stolen. Youth who maintained contact were strikingly similar to youth who discontinued contact.

Contemporary microsurgical concept for the treatment of Cushing's disease: endocrine outcome in 83 consecutive patients.

BACKGROUND: Evidence suggests that occult adenoma remnants are responsible for persistent Cushing's disease (CD) following transsphenoidal surgery (TSS). To optimize the outcome, we have adapted our microsurgical concept. The influence of our surgical strategy on remission rate and pituitary function is presented. DESIGN AND PATIENTS: 83 patients undergoing TSS for newly diagnosed CD. An enlarged resection was performed in 36 patients. A modified exploration technique with radial incisions was performed in 19 patients in whom an adenoma was not readily detectable. RESULTS: The overall remission rate of primary surgery was 84·3% (70/83). A remission rate of 87·5% (63/72) was achieved in microadenomas. Six patients with microadenomas were re-operated for persistence, and hypercortisolism was corrected in five of them. With re-operation included, the overall remission rate for microadenomas was 94·4%. No procedure-related complications occurred in primary surgery. Of the patients in remission, 72·5% had early postoperative random cortisol levels below 2 µg/dl, 17·4% had cortisol levels between 2 and 5 µg/dl, and 10·1% had cortisol levels >5 µg/dl. 15·2% of the patients with microadenomas developed postoperative partial hypopituitarism and 3% diabetes insipidus. No increased rate of hypopituitarism was found with enlarged adenomectomy compared to selective adenomectomy. Only a slightly higher rate of partial hypopituitarism (23·1%) was found if extensive exploration was required. CONCLUSION: With our microsurgical concept, a high initial cure rate is achievable with minimal surgical morbidity. Enlarged adenomectomy has no adverse effect on the rate of postoperative hypopituitarism. Early repeat surgery is a successful option if CD persists.

Real time RT-PCR analysis of thyroglobulin mRNA in peripheral blood in patients with congenital athyreosis and with differentiated thyroid carcinoma after stimulation with recombinant human thyrotropin.

OBJECTIVE: Thyroglobulin (Tg), measured by immunometric assay, is the most sensitive and widely used clinical marker for thyroid cancer progression and relapse. However, these Tg determinations are of limited sensitivity and susceptible to interference by Tg autoantibodies. As a possible diagnostic alternative, we tested a real time RT-PCR protocol to determine Tg mRNA levels in peripheral blood. METHODS: Tg mRNA was determined by real-time RT-PCR using total RNA from peripheral blood. Tg mRNA blood levels were calibrated to the mRNA encoding the housekeeping enzyme glyceraldehyde phosphate dehydrogenase (GAPDH); pooled blood from ten healthy subjects served as a RT-PCR positive control. RESULTS: Tg mRNA and serum Tg were detected in twelve patients with differentiated thyroid cancer (DTC) after thyroidectomy and radioiodine therapy, however, there was no correlation with the clinical stage. An increase in Tg mRNA and protein was observed after application of recombinant human thyrotropin (rhTSH) in four patients with DTC stimulated with rhTSH for postoperative follow up. Tg mRNA and protein were also detected in four congenital athyreotic patients. Analysis of Tg mRNA levels using a commercial multiple tissue Northern blot revealed Tg hybridization signals in several extrathyroidal tissues (salivary gland, trachea, kidney, pancreas, adrenal gland, etc.). CONCLUSIONS: Our data suggests that RT-PCR detects Tg mRNA of extrathyroidal origin, from leukocytes or from metastasizing carcinoma cells under basal conditions or after TSH stimulation. However, considering the marked and highly variable individual Tg mRNA backgrounds, interpretation of real time PCR results requires caution. This limits the clinical use of Tg mRNA determination by real time PCR to an individual tumor progression marker in follow-up.

The Yorkshire Modular Training Programme: a model for structured training and quality assurance in obstetrics and gynaecology.

Recent changes in postgraduate education have highlighted the need for structured training to ensure quality in training and optimize patient care. In Yorkshire, a "modular" approach to postgraduate education in obstetrics and gynaecology has been adopted through the Yorkshire Modular Training Programme (YMTP). The curriculum for trainees is divided into "modules" organized over five years. This provides a comprehensive educational package covering all aspects of obstetrics and gynaecology for trainees in the specialty. The YMTP provides a framework for region-wide integration and ownership of responsibility for teaching and training. It also provides quality assurance in education throughout the region and provides an "educational continuum" in which the different modules work together to meet the educational requirements of the trainees. It also aims to integrate "training" and "education" for the trainees. This paper describes the organization of the programme including its educational principles. It discusses its strengths and weaknesses. It provides a useful framework for postgraduate education that could be used by other regions.