[RehaFuturReal®: Evaluation of Implementation in Organizational Structure and in Counseling Process - An Overview of Results]. / RehaFuturReal®: Evaluation der Implementierung und Umsetzung - Ein Ergebnisüberblick.

BACKGROUND: Due to prevailing future challenges in vocational rehabilitation, development process RehaFutur (BMAS) was initiated. In this context, recommendations were made to secure a future-oriented, innovative vocational rehabilitation in Germany. Deutsche Rentenversicherung (DRV) Westfalen transferred these recommendations into a new and applicable counseling concept RehaFutuReal(®). Rehabilitation managers (RM) are central protagonists in counseling process. Therefore, RehaFuturReal(®) focused on optimization of counseling performance. To achieve this aim, rehabilitation managers were taught to work with a case management (CM) based approach. RWTH Aachen supported RehaFuturReal(®) from an academic point of view and conducted a formative and summative evaluation. Primary aim of RWTH Aachen was to support DRV Westfalen during implementation of RehaFuturReal(®) into their organizational structure. Additionally, RWTH Aachen controlled whether transfer of RehaFutuReal(®) in counseling process was successful. METHOD: From 04-01-13 until 12-31-14, RehaFuturReal(®) was tested by DRV Westfalen in the intervention district Dortmund with 10 RM. There were 3 selection criteria for the overall sample of N=320 insurants: participants were required to have an active employment status, suffered from integration issues and were in need of support to achieve vocational integration. Evaluation of RehaFuturReal(®) was realized summative (pre-post-comparison) and formative (process-orientated). Evaluative judgment regarding implementation in organizational structure and counseling process was performed by using three-stage-concept of Donabedian (quality of structure, process and results). Thereby, feedback of RM, insurants and employers was taken into account. RESULTS: Analysis of evaluation results revealed a positive overall impression. Implementation into organizational structure was successful on all 3 quality stages: concept of project and CM-training were an adequate basis and appropriately put into practice by fulfilling prescribed objectives, topics and schedule (quality of structure). Rehabilitation managers identified themselves with the implementation process into DRV Westfalen (grading of CM training: M=1,67; SD=0,65; quality of process). Analogous, consultants reported a high level of satisfaction during implementation of new counseling process (possible span: 1-4; M=3,11; SD=0,33; quality of results). Regarding implementation of counseling process, sample fitted into 3 selection criteria wherefore the correct insurants were picked in RehaFuturReal(®) (quality of structure). CM-orientated counseling approach was properly implemented into everyday work of RM by using CM-instruments for documentation (quality of process). RM were highly satisfied (possible span: 1-4) with counseling performance (M=3,43; SD=0,77). Employers also rated counseling performance positively (M=3,38; SD=0,85). By contrast, surveying insurants revealed a heterogeneous impression of satisfaction (M=2,97; SD=1,03) (quality of results).

[Relevance of Personality Factors for Successful Vocational Rehabilitation]. / Die Bedeutsamkeit von Persönlichkeitsfaktoren für den beruflichen Rehabilitationserfolg.

BACKGROUND: The Main purpose of vocational rehabilitation is occupational reintegration of clients into the job market who have lost their job or whose job is threatened because of a handicap or chronicl illness. With regard to existing evidence for the relevance of personality factors for work performance and job achievement, the present study investigated the influence of participants' personality factors on a successful reintegration after a retraining program in a vocational training center over 2 years. A central research objective was to identify prognostic personality factors for successful vocational integration. METHOD: In this longitudinal study 15 vocational training centers participated at 3 time points of measurement (T1, T2 and T3). Data gathering was based on rehabilitants' self-reports (standardized questionnaires: SVF, BSW, SPR, CSES) about personality aspects. First data collection started at the beginning (T1) and a second survey was conducted at the end of the training 2 years later (T2). Based on the data at measurement points T1 and T2, 4 prognostic models were computed (binary logistic regression analysis) and evaluated, examining the differenzial influence of several scales and items on direct reintegration after completing the vocational retraining and reintegration status 6 months later (T3). RESULTS: As expected, different variables turned out to be relevant for occupational integration at the end of the training program and 6 months later. Correspondingly other variables appeared to be relevant for occupational reintegration at T1 and at T2. At the end of the vocational training program, approximately 24% of the participants had a job. With respect to direct reintegration, regression analysis revealed that vocational self-efficacy (R(2)=0,175) and self-evaluation were relevant (R(2)=0,383). Approximately 70% of the participants had gotten a job 6 months later. Several stress coping strategies (R(2)=0,170), estimation of the own reintegration prognosis and aspects like vocational center contextual factors (R(2)=0,280) appeared to be relevant for reintegration 6 months later.

Immunoperoxidase technique for detecting spirochetes in tissue sections: comparison with other methods.

BACKGROUND: With the increasing incidence of human immunodeficiency virus (HIV) infection and immunosuppressive therapy, the incidence of syphilis has been increasing. Given the fact that the above conditions may mask or obscure the usual clinical signs and symptoms of syphilis, a means of enhanced detection is essential. AIMS METHODS: The purpose of this study was to determine whether an immunoperoxidase method using an antibody against treponemes would increase the sensitivity and specificity of diagnosis in biopsies of patients with secondary syphilis. This was compared to serology and silver stain in cases of known syphilis. RESULTS: Immunoperoxidase for treponemes was at least as sensitive (9/10) as pathology (9/10), and more sensitive than conventional silver stain (6/10) or serology (7/10). CONCLUSIONS: In those equivocal cases of secondary syphilis, where confirmation is essential, immunoperoxidase for treponemes may be a useful adjunct.

Identification of melanoma antigens that are immunogenic in humans and expressed in vivo.

BACKGROUND: In the development of an antimelanoma vaccine, a critical factor is the identification of antigens that induce a strong immune response in humans and that are expressed by melanoma cells in vivo. The aim of this study was to identify candidate antigens for such vaccine. METHODS: Sixty-nine patients with surgically resected melanomas (American Joint Commission on Cancer [AJCC] stage III) were immunized with a polyvalent vaccine containing multiple melanoma antigens. Antimelanoma antibodies generated in the patients' sera were used as probes to identify the melanoma antigens that are immunogenic in humans and that are expressed on the tumor tissue in vivo. Such responses were determined by an immunoblotting assay that employed an antigen source prepared from membrane fractions of freshly excised melanoma tissue. RESULTS AND CONCLUSIONS: Vaccine treatment stimulated antibody responses in 35 (51%; 95% confidence interval [CI] = 39%-63%) of 69 sequentially enrolled patients. The antibodies were directed to one or more antigens with molecular masses of 45, 59, 68, 79, 89, 95, and/or 110 kd. The most immunogenic antigens were p110 and p68, which induced responses in 33% (95% CI = 22%-44%) and 25% (95% CI = 15%-35%) of patients, respectively. Both antigens were commonly expressed on different melanomas, but they were absent on autologous normal tissue and on an unrelated allogeneic tumor. All the above antigens are attractive candidates for vaccine construction.

Incidence of neuronal ceroid-lipofuscinoses in West Germany: variation of a method for studying autosomal recessive disorders.

The incidence of neuronal ceroid-lipofuscinoses (NCL) in West Germany was determined using a novel method which is applicable to other autosomal recessively inherited diseases. Questionnaires were sent to all pediatric departments (answer rate 189/276, 68%), schools for the blind (39/46, 85%), and neuropathological institutes (15/22, 68%). Diagnoses were accepted only when based on firm clinical and/or electron microscopic criteria; 207 such identified patients were sorted according to year of birth. Plotting the cumulative number of new cases per year against the year of birth resulted in a slightly S-shaped curve. Before the year 1962, the curve is relatively flat, probably due to inefficient case registration. Between 1968 and 1977, the slope of the curve is constant--a steep, nearly straight line. Thereafter the curve flattens out again, likely due to inefficient registration of young, still undiagnosed patients. We interpret the central segment of the curve, which is continuously straight over a period of 10 years and corresponds to 92 patients, as a period in which efficient registration of new cases occurred. The number of live births being 7,211,543 during the same period, the NCL incidence is calculated to be 1.28 per 100,000 live births (0.71 for juvenile NCL and 0.46 for late infantile NCL).

Sudden infant death syndrome in Hamburg. An epidemiological analysis of 150 cases.

A retrospective analysis was carried out of 150 SIDS cases seen in the five year period between 1979 and 1983 in Hamburg, Germany. The overall incidence was 2.3 per 1,000 live births. 82% of all infants and 100% of the preterm infants (corrected according to gestational age) dying of SIDS, died within the first 6 months of life. Infants of mothers less than 18 years of age, infants with more than 2 siblings, infants with birthweight less than 1,500 g and SGA-preterm infants were found to be high-risk subgroups. A high percentage (20% of all cases, 43% of infants with mothers less than 18 years) were underweight at death (under the 3rd weight-percentile). The study emphasizes the complexity of internal and external factors in the etiology of SIDS.

[Mortality and morbidity of thromboembolism in drug prevention--5-year analysis]. / Thromboembolieletalität und -morbidität bei medikamentöser Prophylaxe--eine 5-Jahresanalyse.

In a period of five years a general medical prevention of postoperative venous thromboembolic disease was tested in major gynaecological operations, in patients undergoing radium insertions for gynaecological cancer and in patients with caesarean section. Preoperatively was the beginning of the daily therapy with Dihydroergotamine (DHE) and every four days the therapy with Acetylsalicylic acid (ASS). The results of 2,346 therapy-cycles with medical prevention of thromboembolic disease in 2,280 patients are reported. Risks of thromboembolic disease were in 63% of the gynaecologic patients (mean age 52.4 +/- 8.9 years) and in 34% of the obstetrical patients (mean age 24.6 +/- 5.1 years). Postoperative bleeding complications occurred in 12 cases (0.5%) and the number of reoperations was lower than 1 0/00). Postoperative thromboembolic complications were found clinically and radiologically in 0.3% of the patients. Letal embolism of the lung happened in 2 patients (0.9 0/00). A general medical prevention of thromboembolic disease with DHE and ASS can be recommended because of the low rate of postoperative bleeding complications and of the reduced rate of postoperative thromboembolic disease. A prevention of thromboembolic disease by individual dosage of heparin must be considered in patients at high risk for thromboembolic disease.

[Experiences with the use of sulprostone (Nalador) for the termination of pregnancy in the 1st trimester in primigravidae]. / Erfahrungen beim Einsatz von Sulproston (Nalador) zum Schwangerschaftsabbruch im 1. Trimenon bein Primigravidae.

Sulprostone in different doses and application forms (25, 50 or 100 micrograms extra-amnionic; 500 micrograms or 3 times 500 micrograms every 4 hours intramuscularly) was given to perform termination of pregnancy between 7th and 12th week. The dose of 500 micrograms three times given was most effectiveness, but there were the most side effects, too. The dose of 500 micrograms Sulproston was accompanied by less side effects and the therapeutic success was sufficient. The extra-amnionic application was effective also in all used dosages.

[Areas of psychosocial care of children with cancer and their families. Evaluation of a model of comprehensive care]. / Bereiche psychosozialer Betreuung krebskranker Kinder und ihrer Familien. Auswertung eines ganzheitlichen Versorgungsmodells.

98 children with cancer and 7 children with other serious hematologic or oncologic illnesses and their families are counselled by psychologists in close teamwork with pediatric oncologists within the framework of a clinical pilot study in 1982. The problems and questions of interest posed on the psychologists in 646 such contacts are classified and presented according to frequency of problems and contacts. The resulting large number and variety of concerns demonstrates that in addition to the direct illness- and treatment-related coping strategies (52 %) and related social/economic questions (30 %), a considerable portion of the problems can be classified within the realm of the clinical psychologist: behavioral disorders (37 %), family problems (33 %), late effects (26 %).

[Development, structure and initial evaluation of a comprehensive psychosocial care program for children with cancer and their families]. / Entwicklung, Struktur und erste Auswertung umfassender psychosozialer Betreuung krebskranker Kinder und ihrer Familien.

The development and trial of a model care program carried out by psychologists in close collaboration with oncologists aimed at the comprehensive in- and off-ward care of children with cancer and their families is reported. A structured psychosocial anamnesis in interview-form ("Aufnahmebogen") and an information list ("Checkliste") are used shortly after diagnosis to identify problems and to systematically inform on psychosocial support schemes. The procedure allows a comprehensive, early and preventative psychosocial care. An evaluation of 646 carefully documented contacts was carried out according to the criteria: number of contacts, initiator, person contacted, reason for contact and function of the psychologist. Various prerequisites important for the integration of psychologists into the oncological team are specified and discussed.

[3 osteosarcoma therapy dropouts. Clinical cases]. / Therapieabbruch bei 3 Osteosarkom-Patienten. Eine Kasuistik.

We report on 3 cases of male late-adolescent/young-adult osteogenic sarcoma patients who refused complete chemical therapy according to the treatment plan "COSS 80". They all originated from disturbed family situations. Characteristic was their early independence and autonomy, dominance tendency, low level of self control, and high level of sociability. Primary motivation for refusal was the experienced intolerability of the chemotherapeutical side-effects and extreme fear of medical procedures (e.g. injections).

Activity and excitability to electrical current of cortical auditory receptive neurons of awake cats as affected by stimulus association.

1. Unit activity and excitability were studied at the midlateral and suprasylvian cortex of naive, blink-conditioned and "randomization" cats. The latter received the same CS and US as did the conditioned animals, but in random temporal order and with random intertrial intervals with mean comparable to that used for conditioning. The randomization group failed to develop a blink CR. 2. With conditioning, spontaneous and evoked unit discharges were increased above levels found in naive animals. Correspondingly, levels of extracellularly injected current required to elicit a spike discharge were lower in conditioned than in naive animals. In addition, in the conditioned animals, the degree of enhancement of evoked activity and excitability was found to be greatest in the units that responded to the CS, as opposed to units that responded to another auditory stimulus of equal intensity but of no special behavioral significance vis-a-vis the conditioned reflex. 3...

[Total estrogens and estrogen-creatinine ratio in pregnancy]. / Gesamtöstrogene und Ostrogen-Kreatinin-Ratio in der Schwangerschaft

The ratio of estrogen excretion in urine (milligrams per 24 h) divided by creatinine (grams per 24 h) was determined in 571 specimens of 307 pregnant women and compared with total estrogen determinations. Use of estrogen-creatinine ratio reduced the daily variations of total estrogen values by one third resulting in a mean curve with less standard deviation.

PIP: Estrogen levels in pregnant women provide a means of monitoring the feto-placental bond, since in late pregnancy, estriol is produced by the fetal adrenal rind. The colorimetric method, using urine, is simple, but it has a relatively high standard deviation, and its accuracy is decreased where estrogen concentrations are low. Collection errors and daily variations in amount of urine voided are additional sources of error. The feasibility of using the estrogen-creatinine ratio to improve accuracy of estrogen determination was investigated, taking 571 urine samples from 307 women with normal pregnancies. Total estrogen excretion and estrogen-creatinine ratios were measured, tabulated, and plotted. The standard deviation was 38.7%, on the average, for total estrogens, 25.4% for the estrogen-creatinine ratio. The mean curve for the ratio corresponded more nearly with the course of estrogen production observed by other authors, i.e., a steep rise in early pregnancy, a plateau from Weeks 28 to 32, and a further steep rise in the last weeks. The method described above results in reduction in daily variations (which can amount to 50% normally) and reduction in the standard deviation. False diagnoses resulting from errors in collection are avoided by using a ratio. An objection to the ratio method is that it might give a false-normal estrogen reading in the presence of illnesses that decrease kidney function (pregnancy toxemias), but in such cases, a variety of fetal monitoring methods ought to be used, not just 1.