OncoTREAT: a software assistant for cancer therapy monitoring

ObjectCancer is one of the leading causes of death worldwide and therapy options are often associated with severe stress for the patient and high costs. Therefore, precise evaluation of therapy success is essential. Material and Methods In the framework of the VICORA research project (Virtual Institute for Computer Assistance in Clinical Radiology), a software application was developed to support the radiologist in evaluating the response to tumor therapy. The application provides follow-up support for oncological therapy monitoring by volumetric quantification of lung, liver and brain metastases as well as enlarged lymph nodes and assists the user by temporal registration of lesion positions. Results With close cooperation between computer scientists and radiologists the application was tested and optimized to achieve a high degree of usability. Several clinical studies were carried out to evaluate the robustness and reproducibility of the volumetry methods. Conclusion Automatic volumetry and segmentation allows reliable detection of tumor growth and has the potential to increase reliability and significance of monitoring tumor growth in follow-up examinations.     

The role of patient flow and surge capacity for in-hospital response in mass casualty events

Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.     

A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia

Background While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient‐centred care. Objective To estimate the concordance between patients’ and psychiatrists’ (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self‐explicated method in valuing a large number of treatment goals. Design Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5‐point Likert scale. Three scores were calculated based on the ranking (1–20), rating (Likert scale) (1–5) and a self‐explicated method estimated as the product of rating and ranking score (1–100). Concordance was tested using Spearman’s rho for overall ordinal rankings and via anova and F‐test for the cardinal values assigned to a specific treatment goal. Participants A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. Results Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self‐explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self‐explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly (P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. Conclusions While there is an overall concordance between patients’ and psychiatrists’ valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on ‘textbook’ outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference‐based methods, such as the self‐explicated method, in the study of concordance.     

Attitudes of Medical Students Towards Psychiatry

Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on “Attitudes Towards Psychiatry” (ATP-30). Results: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. Conclusion: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.     

Untersuchungen über den Effekt der chronischen Zigarettenrauchinhalation beim syrischen Goldhamster und über die Bedeutung des Vitamin A auf die bei Berauchung gefundenen Organveränderungen

Zusammenfassung Nach chronischer Berauchung syrischer Goldhamster mit Standardzigaretten oder modifizierten Zigaretten wurden im Bereich des Kehlkopfes Leukoplakien verschiedener Schweregrade und Carcinome beobachtet. Häufigkeit und Schweregrad der aufgetretenen Veränderungen waren eindeutig von Dosis und Zeit abhängig. Außerdem hingen sie von der Art der Zigaretten bzw. deren Kondensatgehalt ab. Die Kehlkopfveränderungen waren bei niederem Kondensatgehalt geringer. Die modifizierten Zigaretten bestanden aus 50% Tabakmischung der Standardzigarette und aus 50% Bandtabak, expandiertem Tabak oder Tabakaustauschmaterialien. Die Berauchung führte zu einer Körpergewichtsreduzierung, außerdem zu einer Zunahme der Entzündungen der Nasen- und Mundschleimhaut und der Speichelsteine sowie der Zahl der Raucherzellen in der Lunge. Nicht behandlungsabhängig war die Zahl der Spontantumoren, die Erkrankungen der Leber, Milz, Niere und Nebeniere sowie der Gefäße, deren Häufigkeit durch die Berauchung nicht verändert wurde. Nach zusätzlicher chronischer Applikation von Vitamin A kam es zu einer starken Zunahme der papillomatösen Leukoplakien des Kehlkopfes, während die verrucösen Leukoplakien eine deutliche Abnahme erkennen ließen. Eine Zunahme der Carcinome war nicht erkennbar. Es fanden sich häufiger Hyperplasien der Schilddrüse. Die Überlebenszeit war bei den mit Rauch und Vitamin A behandelten Tieren verkürzt. Bei den nur mit Vitamin A behandelten Tieren fanden sich häufiger Dysplasien und Carcinome im Verdauungstrakt.

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Studies on the effect of chronic cigarette smoke inhalation in Syrian Golden Hamsters and the importance of Vitamine A on morphological alterations after smoke exposure

Summary Chronic inhalation of cigarette smoke from reference cigarettes and modified cigarettes induced different stages of leucoplakias and carcinomas in the larynx of Syrian Golden Hamsters. Incidence and intensity of alterations were distinctly dose- and time-dependent; moreover, they were dependent on cigarette type or its tar content. Laryngeal changes were less in the group exposed to smoke from cigarettes with a low tar content. Modified cigarettes were made from 50% of the tobacco mixture from reference cigarettes and 50% of puffed tobacco, tobacco sheets or new smoking material. Smoke exposure reduced body weight and increased inflammations of the nasal and oral cavity as well as the number of ptyaloliths and the incidence of smoke-cells in the lung. The number of spontaneous tumors and findings in the liver, spleen, kidney and adrenal glands as well as vascular diseases were not dependent on treatment. Additional chronic treatment of Vitamine A induced a considerable increase of laryngeal papillary leucoplakias and a distinct decrease of verrucous leucoplakias. An increased incidence of carcinomas could not be observed. Animals treated with Vitamine A and smoke showed more often tumors in the thyroid gland. The survival time was reduced. Animals treated only with Vitamine A showed an increased rate of dysplasias and carcinomas in the digestive tract.

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Die Arbeit wurde im ehem. Forschungsinstitut der Cigarettenindustrie e.V., Hamburg, durchgeführt     

Narkose im Rettungsdienst

Zusammenfassung Gegen die Durchführung einer Narkose im Rettungsdienst bestehen deutliche Vorbehalte, weshalb aktive Not?rzte zu ihren Erfahrungen mit der pr?klinischen Durchführung befragt wurden. 44% der Not?rzte waren An?sthesisten mit mehrj?hriger Rettungsdienst- und An?sthesieerfahrung. In 61% der F?lle wurden die Narkosen im Rettungsdienst bei traumatologischen Notfallpatienten durchgeführt, wobei Barbiturate in 55% der F?lle verwandt wurden. W?hrend im klinischen Bereich Ketamin bei Narkosen nur in 5% zum Einsatz kam, war es im Rettungsdienst in 16% der F?lle das Narkotikum der Wahl. 53% der Not?rzte verwenden im Rettungsdienst Relaxantien und 47% grunds?tzlich nicht. Sofern eingesetzt, war Succinylcholin am h?ufigsten verwandt worden (39%). Die Vor- und Nachteile alternativer Narkotika speziell unter dem Gesichtspunkt der Eignung für den pr?klinischen Einsatz werden diskutiert und die Forderung erhoben, die Durchführung der Narkose im Rettungsdienst in der Fortbildung der Not?rzte zu intensivieren. Eingegangen: 12. September 1996 Akzeptiert: 22. September 1996     

Degradation of dimeric lignin model compounds by aerobic bacteria isolated from the hindgut of xylophagous termites

The capability of the intestinal flora from the gut of xylophagous termites of degrading lignin model compounds was investigated. Different dimeric lignin model compounds-degrading bacteria were obtained from the hindgut flora of Mastotermes darwiniensis FROGGATT , Reticulitermes santonensis FEYTAUD , Nasutitermes nigriceps HALDEMAN and Zootermopsis angusticollis HAGEN . In the presence of oxygen dimeric model compounds were degraded by all isolates. This indicates that the hindgut flora of termites is basically able to produce substrate for their host from aromatic extractives of wood.