[Nutrition patterns in German breast cancer patients]. / Wie ernähren sich Frauen mit Brustkrebs in Deutschland?

BACKGROUND: Several studies could demonstrate an association between nutrition and the risk of breast cancer. PATIENTS AND METHODS: In this study we examined the daily diet of German patients with breast cancer approximately 12 months after diagnosis. In a prospective trial nutritional habits were evaluated in 165 breast cancer patients on admittance to an inpatient medical rehabilitation program. RESULTS: The results of this survey show that patients with breast cancer report on a nutritional pattern which is characterised by a (very) low consumption of grains, vegetables, fruits und fish and a high consumption of meat and processed meat. Due to epidemiological data, it may be hypothesized that the patients' diet might have contributed to the development of their disease. CONCLUSION: Our results underscore the need for nutritional counselling of breast cancer patients, as they show a relatively unfavourable nutrition pattern which differs from currently available advice. An inpatient rehabilitation programme could be an adequate starting point for this purpose.

Effect of blood product transfusion-induced tolerance on incidence of cardiac allograft rejection.

BACKGROUND: Blood product transfusion has been successfully used in solid-organ transplantation to induce tolerance. Whether a similar protective effect of blood product transfusion exists in heart transplantation is controversial. OBJECTIVE: To investigate the effect of cellular blood product transfusion within 2 weeks posttransplantation on the incidence of cellular and antibody-mediated rejection. PATIENTS AND METHODS: Patients were grouped on the basis of number of blood transfusions; group 1 received no transfusions, and groups 2, 3, and 4 each received an incremental number of transfusion units. All endomyocardial biopsy samples were routinely studied using immunofluorescence in the first 12 weeks posttransplantation. RESULTS: Baseline characteristics including age, sex, body mass index, history of diabetes, donor characteristics, and pretransplantation laboratory values were similar except that group 4 had a higher rate of previous sternotomy and longer ischemic time during transplantation. Approximately 9200 endomyocardial biopsy samples composed the data. Short- and long-term freedom from the International Society for Heart & Lung Transplantation grade 3A or higher cellular rejection and from antibody-mediated rejection were comparable between groups. CONCLUSIONS: Blood transfusions within the first 2 weeks post-transplantation do not seem to confer any protective effect against posttransplantation cellular rejection or antibody- mediated rejection. Whether other unmeasured confounding factors mask their effect requires further prospective studies.

[Herbal medications. Possible importance for anaesthesia and intensive care medicine]. / Phytopharmaka. Mögliche Bedeutung für Anästhesie und Intensivmedizin.

There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published.

What leaders really do.

Leadership is different from management, but not for the reasons most people think. Leadership isn't mystical and mysterious. It has nothing to do with having "charisma" or other exotic personality traits. It is not the province of a chosen few. Nor is leadership necessarily better than management or a replacement for it. Rather, leadership and management are two distinctive and complementary systems of action. Each has its own function and characteristic activities. Both are necessary for success in today's business environment. Management is about coping with complexity. Its practices and procedures are largely a response to the emergence of large, complex organizations in the twentieth century. Leadership, by contrast, is about coping with change. Part of the reason it has become so important in recent years is that the business world has become more competitive and more volatile. More change always demands more leadership. Most U. S. corporations today are overmanaged and underled. They need to develop their capacity to exercise leadership. Successful corporations don't wait for leaders to come along. They actively seek out people with leadership potential and expose them to career experiences designed to develop that potential. Indeed, with careful selection, nurturing, and encouragement, dozens of people can play important leadership roles in a business organization. But while improving their ability to lead, companies should remember that strong leadership with weak management is no better, and is sometimes actually worse, than the reverse. The real challenge is to combine strong leadership and strong management and use each to balance the other.

What effective general managers really do.

A rather large gap exists between the conventional wisdom on management functions, tools, and systems on the one hand and actual managerial behavior on the other. The former is usually discussed in terms of planning, controlling, staffing, organizing, and directing; the latter is characterized by long hours, fragmented episodes, and oral communication. Actual behavior, as a study of successful general managers shows, looks less systematic, more informal, less reflective, more reactive, less well organized, and more frivolous than a student of strategic planning systems, MIS, or organizational design would ever expect. The gap is important and disturbing for many reasons. First of all, it raises serious questions about the kind of formal planning, performance appraisal, and other systems that are commonly in use today. In a similar way, it raises questions about management education, which usually relies heavily on management "theory" and which is currently producing more than 60,000 new MBAs each year. Furthermore, the gap makes it difficult for executives to coach younger managers and makes it hard for them to know how they might improve their own effectiveness.

Managing your boss: a compatible relationship with your superior is essential to being effective in your job.

Good managers recognize that a relationship with a boss involves mutual dependence and that, if it is not managed well, they cannot be effective in their jobs. They also recognize that the boss-subordinate relationship is not like the one between a parent and a child, in that the burden for managing the relationship should not and cannot fall entirely on the boss. Bosses are only human; their wisdom and maturity are not always greater than their subordinates'. Effective managers see managing the relationship with the boss as part of their job. As a result, they take time and energy to develop a relationship that is consonant with both persons' styles and assets and that meets the most critical needs of each.

Choosing strategies for change.

Change, though traumatic, can be good for some people, but many others, especially in their daily employment, feel threatened by any alteration in the status quo. Organizations by their very nature must change, and increasingly rapidly--and managers must implement changes and overcome resistance to them. Here are four basic reasons people resist change, various ways of dealing with that resistance, and a guide to the kinds of approaches to use with different types of opposition.