End-of-life decision making by Austrian physicians - a cross-sectional study.

BACKGROUND: Austria has recently been embroiled in the complex debate on the legalization of measures to end life prematurely. Empirical data on end-of-life decisions made by Austrian physicians barely exists. This study is the first in Austria aimed at finding out how physicians generally approach and make end-of-life therapy decisions. METHODS: The European end-of-life decisions (EURELD) questionnaire, translated and adapted by Schildmann et al., was used to conduct this cross-sectional postal survey. Questions on palliative care training, legal issues, and use of and satisfaction with palliative care were added. All Austrian specialists in hematology and oncology, a representative sample of doctors specialized in internal medicine, and a sample of general practitioners, were invited to participate in this anonymous postal survey. RESULTS: Five hundred forty-eight questionnaires (response rate: 10.4%) were evaluated. 88.3% of participants had treated a patient who had died in the previous 12 months. 23% of respondents had an additional qualification in palliative medicine. The cause of death in 53.1% of patients was cancer, and 44.8% died at home. In 86.3% of cases, pain relief and / or symptom relief had been intensified. Further treatment had been withheld by 60.0%, and an existing treatment discontinued by 49.1% of respondents. In 5 cases, the respondents had prescribed, provided or administered a drug which had resulted in death. 51.3% of physicians said they would never carry out physician-assisted suicide (PAS), while 30.3% could imagine doing so under certain conditions. 38.5% of respondents supported the current prohibition of PAS, 23.9% opposed it, and 33.2% were undecided. 52.4% of physicians felt the legal situation with respect to measures to end life prematurely was ambiguous. An additional qualification in palliative medicine had no influence on measures taken, or attitudes towards PAS. CONCLUSIONS: The majority of doctors perform symptom control in terminally ill patients. PAS is frequently requested but rarely carried out. Attending physicians felt the legal situation was ambiguous. Physicians should therefore receive training in current legislation relating to end-of-life choices and medical decisions. The data collected in this survey will help political decision-makers provide the necessary legal framework for end-of-life medical care.

[Education, advanced and further training in the field "psychology in rehabilitation"]. / Aus-, Fort- und Weiterbildung "Psychologie in der Rehabilitation"

The commission for vocational training, training and further education of the German Society of Rehabilitation Science tends to discuss and to give recommendations for various professions in rehabilitation. The working group, which is led by J. Bengel/Freiburg and M. Morfeld/Magdeburg-Stendal created an inventory of Rehabilitation Psychology. The training programs for Rehabilitation Psychology at universities and universities of applied science in Germany are based on a job profile of psychologists in medical and vocational rehabilitation. The different universities have diverse priorities focusing on Rehabilitation Psychology. The offer changes because of the adaption of requirements and implementation of Bologna Reform. The training and further education offers are specific and available for large indication areas. Finally outstanding issues and problems are pointed out.

[A comparison of multimodal programmes of patient education in the rehabilitation of chronic low back pain]. / Multimodale Interventionsprogramme in der Rehabilitation von Patienten mit chronischen Rückenschmerzen--Ein Vergleich.

There is growing evidence for the effectiveness of multimodal intervention concepts for chronic low back pain in the international literature, and accordingly several German rehabilitation programmes for the treatment of chronic low back pain patients have been developed. Focus of this paper is to describe and compare frequently used German multimodal intervention programmes for in- and outpatient rehabilitation of patients with chronic low back pain. Programmes were chosen by searching the most relevant online resources as well as the online pages of Deutsche Rentenversicherung and Zentrum Patientenschulung during September 2008. Keywords guiding the search were: Patientenschulung, Rückenschmerzen, Manual, psychologische multimodale Interventionskonzepte, Rehabilitationsprogramm, psychology, intervention, low back pain, manual and therapy. By this means, six manually supported multimodal rehabilitation programmes for the in- and outpatient therapy of patients with chronic back pain could be identified: Göttinger Rücken-Intensiv-Programm (GRIP), the psychological programme for chronic head- and low back pain, the Münchner Rücken-Intensiv-Programm (MRIP), Back to Balance, Arbeiten und Leben--Back to Balance (ALEBABA) und Rückenfit: Lebenslust statt Krankheitsfrust. These programmes are depicted and compared with regard to their potentials and limitations in supporting the rehabilitation process of patients with chronic low back pain. While comparing the programmes, a number of similarities between them can be detected, as well as pronounced differences, e. g., regarding settings and complexity. In most programmes, lack of appropriate evaluation studies and lack of aftercare turn out to be critical aspects.

Electrochemiluminescence from tunicate, tunichrome-metal complexes and other biological samples.

Low level intrinsic electrochemiluminescence (ECL) was induced from body fluids and homogenized tissues of oysters and several species of tunicates. No significant ECL was detected in human blood cell lysates, or bovine haematin, but minor ECL was observed in avian blood cell lysates. Both terrestrial grass and seagrass exhibited ECL, which is probably attributable to chlorophyll, since dead (brown) grass did not demonstrate ECL. It was postulated that organic-metal complexes in marine invertebrates were, at least in part, responsible for the intrinsic ECL, since such animals are known to be rich in organically bound metals. However, alternative biochemical mechanisms for the observed ECL, which do not involve metal chelates, are possible. Various metal ions were added to the invertebrate preparations to determine whether exogenous metals could enhance or inhibit the ECL reactions. Strongly oxidizing metal ions such as Ag+, Au+, Cu2+, Hg2+ and Sb2+ at > or = 100 ppm severely inhibited the intrinsic ECL response. No statistically significant ECL enhancement due to addition of metal ions was noted. ECL "profiles' were generated which demonstrated differences in the ECL responses of individual tunicate preparations to the presence of various exogenous metal ions. Differences in ECL profiles may represent differences in types or levels of endogenous metal chelates or other biochemical constituents. In addition, synthetic tunichromes (tunicate pigments) were analysed for ECL in the presence and absence of various added metal ions. One synthetic tunichrome isomer demonstrated a specific ECL interaction with Hg2+, while the other demonstrated broader ECL activity with several metal ions.

Effect of sodium cis-beta-4-methoxybenzoyl-beta-bromacrylate (Cytembena) on HeLa cell kinetics.

The treatment of HeLa cells with various concentrations of sodium beta-4-methoxybenzoyl-beta-bromacrylate (Cytembena) results in inhibition of growth and modification of cell cycle distribution. These phenomena were observed at concentrations between 7.5 x 10(-5) and 2.5 x 10(-5) M. The estimation of DNA content by flow cytometry showed an important shift in the distribution of cycling cells with a relative decrease of G0 + G1 cells and a striking accumulation of G2 + M cells. According to our experimental conditions, the blocking up in G2 + M is irreversible at 7.5 and 5 x 10(-5) M.

[Effects of prolonged physical training on cardiac physiology and morphology in the growing rat using various lipid treatments]. / Effets d'un entraînement physique prolongé sur la physiologie et la morphologie cardiaques du rat en croissance soumis à différents régimes lipidiques.

Weanling male Wistar rats which had been fed for 12 weeks purified diets containing 15% by weight of sunflower oil (SF), high erucic acid rapeseed oil (HEAR) or low erucic acid rapeseed oil (LEAR) and subjected to a treadmill program were compared with sedentary animals fed the same diets, on the basis of cardiac morphology and performances. The rats were trained 5 days a week for 12 weeks, and the speed and duration of the run were progressively increased over 6 weeks until the animals ran continuously for 50 min at 22 m/min with a 4% incline. The following main results were obtained: 1. Food consumption and growth rate decreased in trained animals (Table II). Resting heart rates were not slowed down by training, but were higher in rats fed SF or HEAR than in animals fed LEAR (Fig. 1). Trained animals showed an increasing fatigue during exercise, particularly those fed LEAR (Fig. 2). 2. The ratios of heart weight, muscle weight, kidney weight to body weight, were higher in trained animals, but absolute organ weights were similar in control and trained rats. 3. HEAR caused the highest incidence and number of heart lesions both in sedentary and in trained rats, but in the latter there was a highly significant increase in the number of lesions (Table III). 4. Physical training had different effects on cardiac performances according to the nature of the dietary oil. Thus, the rate of left ventricular pressure rise (dP/dt) decreased only in rats fed, SF or HEAR (Table IV).

[Inhibitory effect of cytembena (sodium-cis-beta-methoxybenzoyl-beta-bromoacrylate) on the cell kinetics of HeLa cells in culture]. / Effet inhibiteur du Cytembena (cis-beta-methoxybenzoyl-beta-bromacrylate de sodium) sur la cinétique des cellules HeLa en culture.

The inhibiting effect of Cytembena on HeLa cell kinetics has been demonstrated and analyzed. The percentage of cycling cells decreases, according to the concentration, between 7.5 and 2.5 x 10(-5) M. Estimation of DNA by cell flow cytophotometry shows an important shift in the distribution of cycling cells with a relative decrease of G1 cells and a very important accumulation of G2 cells. According to our experimental conditions, the blocking up in G2 is irreversible only at 7.5 x 10(-5) M.

Reinforcement rate and interresponse time differentiation.

Reinforcement rate and differential reinforcement of IRTs were independently manipulated to assess their relative contribution to the control of interresponse times (IRTs). Modified percentile reinforcement schedules (Platt, 1973) allowed control of reinforcement rate while longest or shortest IRTs were selectively reinforced. In the absence of differential IRT reinforcement, mean IRT decreased with increasing reinforcement rate. Compared to this small effect of reinforcement rate, reinforcement of long IRTs produced large changes in mean IRT at constant reinforcement rates. No interaction of reinforcement rate and IRT reinforcement was detected. The demonstration of large IRT changes in the absence of reinforcement-rate changes indicates the precedence of IRT reinforcement over molar reinforcement-rate correlations in the determination of IRTs in these procedures.

Differentiation of press durations with upper and lower limits on reinforced values.

Rats received food following lever-press durations between t and t+t' sec where t was 2, 4, or 8 sec and t' was 0.25t, 0.50t, or 1.00t sec. Modal press durations were greater than t but less than t+t' in all cases. Distributions of press durations were lower and broader for larger values of t. Lower t'/t ratios produced lower median press durations and relatively narrower press-duration distributions. Median press duration was a power function of t within a t'/t ratio condition, corresponding to previous results for latency, interresponse time, and response durations.

Rats' lever-press durations as psychophysical judgements of time.

Hungry rats received food following lever-press durations exceeding a minimum value, which ranged from 0 to 6.4 sec. When no intertrial intervals separated successive presses, modal press durations remained at very short values as the minimum value required for food was increased. This was particularly true immediately after a food presentation. When an 8-sec intertrial interval followed each lever release, modal press durations were always at or beyond the minimum value required for food, and outcome of the preceding press had no effect on press duration. Possible reasons for the effects of intertrial intervals included punishment of short presses, increased delay of reinforcement of short presses, and reduced density of reinforcement. In addition, functions relating discrete-trials lever-press duration to minimum duration required for food were found to be qualitatively and quantitatively similar to the power functions recently proposed by Catania (1970) for interresponse time and response latency. This similarity was taken as support for a general psychophysical law of temporal judgments.