The OUTREACH study: oncologists of German university hospitals in rotation on a palliative care unit-evaluation of attitude and competence in palliative care and hospice.

PURPOSE: The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. METHODS: This national prospective multicenter pre-post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire. RESULTS: From March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0-19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequently represented were medical oncology (n = 15), and anesthesiology (n = 11). After the rotation, median palliative care knowledge increased from 81.1% to 86.5% (p < .001), and median palliative care self-efficacy expectations scores increased from 38 to 50 points (p < .001). The effect of the 12-month rotation was not significantly greater than that of the 6-month rotation. CONCLUSION: An educational rotation presented in a specialized palliative care unit for at least six months significantly improves palliative care knowledge and palliative care self-efficacy expectations of physicians from various medical backgrounds.

Palliative care outpatients in a German comprehensive cancer center-identifying indicators for early and late referral.

PURPOSE: Despite that early integration of palliative care is recommended in advanced cancer patients, referrals to outpatient specialised palliative care (SPC) frequently occur late. Well-defined referral criteria are still missing. We analysed indicators associated with early (ER) and late referral (LR) to SPC of an high volume outpatient unit of a comprehensive cancer center. METHODS: Characteristics, laboratory parameters and symptom burden of 281 patients at first SPC referral were analysed. Timing of referral was categorized as early, intermediate and late (> 12, 3-12 and < 3 months before death). Ordinal logistic regression analysis was used to identify factors related to referral timing. Kruskal-Wallis test was used to determine symptom severity and laboratory parameter in each referral category. RESULTS: LRs (50.7%) had worse scores of weakness, loss of appetite, drowsiness, assistance of daily living (all p < 0.001) and organisation of care (p < 0.01) in contrast to ERs. The mean symptom sum score was significantly higher in LRs than ERs (13.03 vs. 16.08; p < 0.01). Parameters indicative of poor prognosis, such as elevated LDH, CRP and neutrophil-to-lymphocyte ratio (NLR) (p < 0.01) as well as the presence of ascites (p < 0.05), were significantly higher (all p < 0.001) in LRs. In univariable analyses, psychological distress (p < 0.05) and female gender (p < 0.05) were independently associated with an ER. CONCLUSION: A symptom sum score and parameters of poor prognosis like NLR or LDH might be useful to integrate into palliative care screening tools.

Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months-a comparative study.

PURPOSE: Physical activity (PA) is recommended to improve advanced cancer patients' (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs' attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs' fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP METHODS: Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. RESULTS: At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, ß=2.152, p=0.017; T1, ß =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, ß=-3.187, p=0.044; T1, ß=-3.521, p=0.041). CONCLUSION: Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs' fatigue, physical functioning, and QoL. TRIAL REGISTRATION: German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017.

[Cooperation between intensive care and palliative care : The status quo in German Comprehensive Cancer Centers]. / Zusammenarbeit von Intensivmedizin und Palliativmedizin : Eine Bestandsaufnahme an den deutschen onkologischen Spitzenzentren.

BACKGROUND: For intensive care patients with limited life expectancy the integration of palliative care in intensive care may be beneficial. However, little is known about the extent of this interdisciplinary collaboration. OBJECTIVES: The support given by palliative medicine in German oncological centers and used by the intensive care units should be recorded. MATERIAL AND METHODS: A descriptive survey was conducted in all of the 16 Comprehensive Cancer Centers (CCC) funded by German Cancer Aid. The questionnaires were sent to the head of department of the CCCs' specialized palliative care teams. Data were collected for the year 2016. Quantitative data were analysed to establish frequencies, given as mean and median. A qualitative section asked for trigger factors, i.e., patient characteristics triggering a palliative care consultation. Evaluation was inductively carried out by content analysis according to Mayring. RESULTS: Data from 15 of the 16 CCCs (94%) were obtained between July and August 2017. In 2016, the median of intensive care patients with palliative care consultations was 33 (minimum 0, maximum 100). The median of nine patients were transferred from an intensive care unit to a palliative care unit (minimum 1, maximum 30). Multidisciplinary ward rounds by both intensive and palliative care staff were available in two CCCs on a regular basis. Two CCCs implemented screening tools to integrate specialized palliative care into intensive care. From 23 responses concerning triggers, three categories were established, i.e., "team's decision and attitude", "patient's condition" and "desires of patients and relatives". CONCLUSIONS: Palliative care is available in German CCCs. However, the degree of integration of specialized palliative care into intensive care units is low. Screening tools are available to identify patients with complex needs and to trigger a palliative care consultation. These tools, as well as joint ward rounds of intensive and palliative care staff, can improve the quality of patient centred care.

Fatigue, barriers to physical activity and predictors for motivation to exercise in advanced Cancer patients.

BACKGROUND: In order to counteract fatigue, physical activity (PA) is recommended for all stages of cancer. However, only few advanced cancer patients (ACP) are physically active. Quantitative data with high numbers of ACP reporting barriers to PA are missing. This study aimed to identify barriers to PA in ACP with tiredness/weakness and investigate their motivation towards it. METHODS: Outpatients with metastatic cancer receiving cancer care at a German Cancer Center reporting moderate/severe tiredness/weakness during self-assessment (MIDOS II) were enrolled. We assessed Fatigue-(FACF-F) and Depression (PHQ8) Scores, demographics, cancer-specific parameters, motivation for PA, physical, psychological and social barriers. RESULTS: 141 of 440 eligible patients (32.0%) with different diagnoses agreed to participate. Patients frequently reported "I feel weakened due to my tumor therapy" (n = 108; 76.6%), physical symptoms (tiredness, weakness, dyspnea, joint-problems, pain, nausea [n = 107; 75.9%]) and fatigue (n = 99; 70.2%) as barriers to PA. However, no significant group differences regarding these barriers were found between physically active and inactive patients. Social barriers were rarely chosen. Motivated patients were 5.6 times more likely to be physically active (p < 0.001), also motivation turned out to be the strongest predictor for a physically active behavior (ß = 1.044; p = 0.005). Motivated attitude towards PA was predicted by fatigue (ß = - 2.301; p = 0.008), clinically relevant depression (ß = - 1.390, p = 0.039), knowledge about PA and quality of life (QoL) (ß = 0.929; p = 0.002), PA before diagnosis (ß = 0.688; p = 0.005 and Interest in exercise program (ß = 0.635; p = 0.008). CONCLUSION: "I feel weakened due to my tumor therapy" is the most reported barrier to PA among both, physically and inactive patients. Motivation for PA is the strongest predictor of performing PA. Interest in PA, knowledge about PA/QoL and PA before diagnosis are main predictors of a motivated attitude. Absence/presence of social barriers did not associate with motivation, fatigue and depression proved to be a negative predictor. Programs including information, motivational counseling and individualized training should be offered for ACP to overcome barriers and reduce fatigue. TRIAL REGISTRATION: German Register of Clinical Trials DRKS00012514, registration date: 30.5.2017.

Regaining familiarity with own body after treatment for operable lung cancer - a qualitative longitudinal exploration.

Little is known about the experiences of operable lung cancer patients during treatment in a clinical setting based on fast-track surgery. The study aimed to explore (1) the embodied meaning of illness in patients with operable lung cancer during treatment to 4 months after surgery and (2) patterns of change over time that may affect the patients' daily lives. Twenty patients referred for lung cancer surgery were interviewed three times, corresponding to potential critical transition points following surgery: hospitalisation; hospital-to-home transition; and resumption of daily life activities. Data collection, analysis and interpretation followed a phenomenological hermeneutical approach inspired by Ricoeur and the theoretical framework was grounded in Merleau-Ponty's phenomenology of perception. The findings reveal the process patients went through in regaining familiarity with their own body after lung cancer treatment. Through the post-operative trajectory the patients' resumption of daily activities involved adjusting to a new awareness of everyday life, physical restrictions and their perception of themselves. The findings are expressed in four sub-themes: (1) perceptions of embodied alterations; (2) transformation of embodied structures in the transition from hospital to home was unexpectedly challenging; (3) embodied perceptions of the intersubjective world; and (4) transforming embodied disruptions into bodily awareness. Patients experienced a smooth treatment trajectory regarding physical consequences of illness and treatment which might be due to the fast-track surgery. Clinicians should be aware of patients' experiences of illness to facilitate patient reconstitution of own identity.

Detection of Rev peptides with impedance-sensors--comparison of device-geometries.

Two different impedance-sensor geometries have been compared for the detection of Rev peptides with a molecular weight of 2.4 kDa. Planar, two-dimensional interdigitated capacitor (IDC) sensors with electrode separations of 1.1 microm as well as three-dimensional nanogap-sensors with an electrode separation of 75 nm have been used. Both sensors have been operated at a fixed frequency of 980 MHz. We discuss the specific interaction of the Rev peptide to an immobilized RNA anti-Rev aptamer (9.2 kDa) for peptide concentrations in the range of 100 nM-2 microM. For the IDC sensor, only peptide concentrations above 500 nM gave detectable signals. For the nanogap sensor, the binding process was clearly visible for all concentrations applied. The higher sensitivity of the nanogap compared to the IDC is ascribed to the improved surface-to-volume ratio.

Comparison of antibody and aptamer receptors for the specific detection of thrombin with a nanometer gap-sized impedance biosensor.

Nanogap-impedance biosensors with electrode separations of 75 nm have been fabricated by means of standard optical lithography and a sacrificial layer technique. Due to a large surface-to-volume ratio and high sensitivity, these sensors are superior compared to open interdigitated electrode structures. As a model, the blood coagulation factor thrombin was detected. As specific receptors, either an antibody or a RNA-aptamer have been used. The microwave frequency impedance measurements showed that both ligands were equally suitable for the specific detection of thrombin.

Ticks (Acari: Ixodidae) parasitizing wild carnivores in Phu Khieo Wildlife Sanctuary, Thailand.

Ixodid ticks were collected and identified from 8 wild carnivore species in Phu Khieo Wildlife Sanctuary, northeastern Thailand. Six tick species belonging to 4 genera were recovered and identified from 132 individuals. These included Amblyomma testudinarium (n = 36), Haemaphysalis asiatica (n = 58), H. hystricis (n = 31), H. semermis (n = 3), Rhipicephalus haemaphysaloides (n = 3), and Ixodes granulatus (n = 1). Leopard cats (Prionailurus bengalensis) (n = 19) were infested with 4 tick species, whereas yellow-throated marten (Martes flavigula) (n = 4), clouded leopard (Neofelis nebulosa) (n = 2), and dhole (Cuon alpinus) (n = 1) were infested with 3 tick species, Asiatic golden cat (Catopuma temmincki) (n = 2) with 2 species, and marbled cat (Pardofelis marmorata), binturong (Arctictis binturong), and large Indian civet (Viverra zibetha) each infested with 1 species. This information contributes to the knowledge available on the ectoparasites of wild carnivores in Southeast Asia.

A phase I clinical and pharmacokinetic study of the camptothecin glycoconjugate, BAY 38-3441, as a daily infusion in patients with advanced solid tumors.

BACKGROUND: The aim of this study was to define the maximum tolerated dose (MTD), dose-limiting toxicity (DLT) and pharmacokinetics of the camptothecin glycoconjugate BAY 38-3441, administered as an infusion for 30 min on two separate schedules every 3 weeks. PATIENTS AND METHODS: A total of 81 patients with advanced solid tumors were treated with BAY 38-3441 either at doses of 20, 40, 67, 100, 140, 210, 315, 470 and 600 mg/m2/day for 1 day every 3 weeks (single-dose schedule), or at doses of 126, 189, 246, 320 and 416 mg/m2/day once daily for three consecutive days every 3 weeks (3-day schedule). Plasma sampling was performed to characterize the pharmacokinetics of BAY 38-3441 and camptothecin with these schedules. RESULTS: DLTs included renal toxicity, granulocytopenia and thrombocytopenia on the single-day schedule at doses > or = 470 mg/m2/day, and diarrhea and thrombocytopenia on the 3-day schedule at doses > or = 320 mg/m2/day. Other non-DLTs were gastrointestinal, dermatological and hematological. Pharmacokinetics of BAY 38-3441 and camptothecin appear to be dose-dependent, but not linear. CONCLUSIONS: Renal toxicity was dose-limiting for BAY 38-3441 using 30-min infusions on the single-dose schedule. Dose escalation to 470 mg/m2/day is feasible using a 2-h infusion. However, because of the superior safety profile, we recommend the 3-day schedule for BAY 38-3441 at a dose of 320 mg/m2/day as 30-min infusions for further phase II studies.

Capecitabine and irinotecan as first-line chemotherapy in patients with metastatic colorectal cancer: results of an extended phase I study.

BACKGROUND: To define the maximum-tolerated dose (MTD) and to evaluate the dose-limiting toxicities (DLTs) of the combination of capecitabine and irinotecan in patients with metastatic colorectal cancer. PATIENTS AND METHODS: Thirty-seven patients with measurable metastatic colorectal cancer with no prior chemotherapy for metastatic disease were treated at three dose levels (DLs). For the first two dose levels, irinotecan (70 mg/m(2)) was administered once a week for 6 weeks in combination with 2 weeks of capecitabine at 1000 mg/m(2) (DL1) or 1250 mg/m(2) (DL2) twice daily, starting on days 1 and 22. In the last dose escalation step, the dose of irinotecan was increased to 80 mg/m(2) (DL3). One cycle lasted 7 weeks. RESULTS: In the subsequent phase I trial, 96 cycles of capecitabine and irinotecan were administered. At DL3, three out of six patients experienced DLTs (diarrhea, neutropenia, asthenia). In order to confirm the safety of the recommended dose, DL2 was extended to 15 patients. Five patients (33%) showed DLTs at this dose level, which was considered too high to embark on further clinical studies. Subsequently, the starting dose (DL1) was extended to a total of 16 patients, with diarrhea being the main toxicity. The overall response rate was 38% [95% confidence interval (CI) 21% to 58%], with a median response duration of 8.7 months (95% CI 6.4-11.5 months). CONCLUSIONS: The recommended doses for further studies are irinotecan 70 mg/m(2) and capecitabine 1000 mg/m(2). The combination of capecitabine and irinotecan appears to have significant therapeutic efficacy with manageable toxicity.

Immobilization of wild ocelots with tiletamine and zolazepam in southern Texas.

Telazol was used to immobilize nine wild ocelots (Leopardus pardalis) captured in box-traps in southern Texas (USA) between May 1997 and April 1998. Mean (+/- SD) intramuscular dosage rate of 5.05 (+/- 0.76) mg/kg produced an induction time of 3.7 +/- 1.8 min. Duration of cataleptic anesthesia was 67.4 +/- 19.8 min and ocelots stood 50.0 +/- 30.7 min after emergence from cataleptic anesthesia. Ocelots recovered to their preinjection condition 129.7 +/- 28.8 min after first standing and 250.8 +/- 55.1 min after initial injection. We observed no adverse reactions to Telazol aside from minor loss of thermoregulatory control. Telazol administered at 5 mg/kg was an effective and safe immobilizing agent for wild ocelots.

Discrepancy between patients' perspectives, staff's documentation and reflections on basic nursing care.

In recent years, Denmark has witnessed an increasing written and oral debate concerning the quality of basic nursing care. The present study is an attempt to characterize basic nursing care in a Danish hospital by collecting data on patient perceptions of their main somatic problems in seven pre-set categories. These data include documentation of patient problems in corresponding problem categories, and the staff's additional knowledge about patient problems. Triangulation of methods was used. Data were collected on 120 patients and from 22 nurses. The patients had 2.3 problems on average: pain (58%) and sleep (43%) were the problems cited most frequently. Only 31% of patients' experienced problems were documented in the nursing records. The nursing staff had more knowledge than was registered in the nursing records. However, one-third of the patients' problems was totally unknown to the nursing staff. From the patients' point of view, essential aspects of basic nursing care are overlooked in daily clinical practice. The findings show that the method employed is suitable for integration of the patients' perspective.

Notoedric mange in an ocelot (Felis pardalis) from southern Texas.

Notoedric mange was diagnosed in a free-ranging adult male ocelot (Felis pardalis) found dead in April 1994 in southern Texas (USA). The emaciated carcass had no body fat. The heart was enlarged and flaccid. There was a nonpurulent serosanguineous pericardial and peritoneal exudate. Severe encrusted skin lesions and alopecia extended from the head posteriorly to the shoulders. The forelegs and feet were less severely affected. We observed a massive infection of Notoedres cati in skin scrapings. Epidermal lesions included hyperkeratosis and parakeratosis with necrotic debris and foci of acute inflammatory cells surrounding mites and their eggs in the stratum corneum. There was mild acanthosis and spongiosis of the stratum germativum, but no chronic inflammation in the dermis. This is the first confirmed case in the ocelot, but notoedric manage has been reported from the bobcat (Felis rufus) in southern Texas. Thus, notoedric mange could pose an additional threat to the already endangered remnant population of the ocelot.

Immobilization of ocelots and bobcats with ketamine hydrochloride and xylazine hydrochloride.

We immobilized 10 ocelots (Felis pardalis), and 21 bobcats (F. rufus) in south Texas (USA) during March to November 1991 with a mixture of ketamine hydrochloride (KH) and xylazine hydrochloride (XH); two ocelots were immobilized twice. Species were immobilized with (mean +/- SE) 14.7 +/- 1.6 mg KH/kg body mass for ocelots, 13.3 +/- 1.8 mg KH/kg for bobcats, and 1.1 +/- 0.1 mg XH/kg and 1.2 +/- 0.1 mg XH/kg for ocelots and bobcats, respectively. Immobilization times in bobcats were longer (P = 0.08) than in ocelots. Adult female ocelots (18.5 +/- 2.6 mg/kg) needed larger (P < 0.05) doses of KH than adult males (12.0 +/- 1.7 mg/kg). Bobcats were immobilized during summer with lower initial (8.6 +/- 0.9 mg/kg, P < 0.001) and total (10.1 +/- 1.3 mg/kg, P = 0.02) doses of KH than bobcats immobilized in winter (14.5 +/- 1.0 mg/kg, and 18.5 +/- 3.8 mg/kg, respectively); summer immobilization times (44.3 +/- 3.8 min) were also shorter (P = 0.03) than during winter (59.1 +/- 5.2 min). Bobcats immobilized during summer had lower (P < 0.01) initial rectal temperatures (39.4 +/- 0.2 C) than bobcats trapped in winter (41.1 +/- 0.4 C). Overall, we observed no effects of KH-XH dose on body temperature.

Seroepidemiological study of Taenia saginata cysticercosis in Swaziland.

A cross-sectional study of Taenia saginata cysticercosis in Swaziland using a serodiagnostic ELISA for parasite antigen is described. The seroprevalence and the levels of parasite antigen were compared in the sera of cattle from different geographical localities, and from areas of high or low population density. Cattle from the Lowveldt region, which has a hot and dry climate relative to the other areas investigated, exhibited significantly higher serum antigen levels. Seroprevalence was also higher in the Lowveldt but this difference was not found to be significant. Within the Lowveldt, antigen levels were found to be slightly elevated in cattle from more highly populated areas. It is suggested that either human behaviour and/or practices in animal husbandry, or increased susceptibility of cattle to reinfection at certain times of the year, may enhance transmission in the Lowveldt since climatic conditions in this region are not conducive to transmission.

[Prevention and treatment of pressure sores--a neglected research subject? An overview of clinically controlled studies in the period 1987-91]. / Tryksårforebyggelse og -behandling--et forsømt forskningsområde? En gennemgang af klinisk kontrollerede undersøgelser i perioden 1987-91.

Pressure sores are frequently seen in elderly hospitalized patients and leads to prolonged hospitalization and increased morbidity and mortality. The object of this paper was to retrieve the last five years literature regarding prevention and treatment of pressure sores. During the period 1987-1991, 751 papers on this topic were published and indexed in Medline. Only 9 of these papers represented controlled clinical trials. Three of them dealt with prevention, and the remaining 6 with treatment. Although 4 of 9 studies showed statistically significant differences between the actively treated group and the placebo group, none of the studies showed convincing clinical differences. Serious methodological flaws with respect to design, blinding, randomisation, sample size and statistical analysis were found in 8 of 9 studies. None of the clinical controlled studies on prevention of pressure sores showed any statistically significant differences between the control group and treatment with, respectively Prevasore lotion, Foam cushion and Silicore mattress. In the 6 trials on treatment of pressure sores, respectively mucopolysaccharide polysulphate creme, ketanserin creme and air-fluidized beds showed statistically better results than control treatment. We conclude that well-designed controlled clinical trials are needed to establish rational routines for prevention and treatment of pressure sores.

[Factors influencing the corrosion of amalgams]. / Einflussgrössen auf das Korrosionsverhalten von Amalgamen.

In a comparative corrosion test specimen were produced from eleven different amalgams using two different plugging pressures and were exposed to two different corrosive solutions. As was to be expected containing amalgams corroded the most. A more accurate differentiation between the individual non gamma 2 amalgams and the two different plugging pressures was only possible with the stronger corrosive solution. Therefore this solution seemed to be better suited for a standardized corrosion test according to DIN 13904, part 2. The greater plugging pressure inhibits corrosion especially in badly corroding amalgams. This seems to be due to the limited diffusion which is the result of a smaller pore size.

Leprosy in wild armadillos (Dasypus novemcinctus) of the Texas Gulf Coast: epidemiology and mycobacteriology.

A significant prevalence of leprosy has been demonstrated in wild Louisiana armadillos. The Texas Gulf Coast still has endemic human leprosy, and recent mores in Texas have markedly increased armadillo-human contact. Armadillos were screened by physical examination, and by ear-snip and slit-scrape technique. Animals that screened "positive" were sacrificed and necropsied under aseptic conditions. Liver, spleen, gross lesions, and four groups of lymph nodes were cultured for mycobacteria and were studied histologically. Base ratios and DNA homology with Mycobacterium leprae were determined on mycobacteria from two armadillos (and two tissues from one of these); these studies indicate that the organism found in Texas armadillos is M leprae. Twenty-one of the armadillos were leprous--4.66%. The local prevalence varied from 1.0% to 15.4%. Epidemiologic implications of these findings and the occurrence of other concomitant mycobacterial infections are discussed.