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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Corrigendum: Landscape of pediatric cancer treatment refusal and abandonment in the US: a qualitative study. Front Pediatr 2024; 12:1386784. [PMID: 38468872 PMCID: PMC10925743 DOI: 10.3389/fped.2024.1386784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.1049661.].
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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Waltenberger M, Bernhardt D, Diehl C, Meyer B, Straube C, Wiestler B, Wilkens J, Zimmer C, Combs SE. Hypofractionated Stereotactic Radiotherapy vs. Single Fraction Stereotactic Radiosurgery to the Resection Cavity of Brain Metastases after Surgical Resection (SATURNUS trial): A Prospective, Randomized Phase III Trial. Int J Radiat Oncol Biol Phys 2023; 117:e155. [PMID: 37784743 DOI: 10.1016/j.ijrobp.2023.06.979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The brain is a common site for metastases. Resection of large or symptomatic metastases is followed by stereotactic radiotherapy to prevent local recurrence. The optimal fractionation scheme is subject of ongoing research. Supported by emerging retrospective data, we hypothesize that hypofractionated stereotactic radiotherapy (HFSRT) is superior to single-fraction stereotactic radiosurgery (SRS) in terms of local control (LC). We designed the SATURNUS trial to prospectively demonstrate the superiority of HFSRT over SRS after resection of brain metastases in terms of LC. MATERIALS/METHODS The SATURNUS trial is a prospective, randomized phase III trial, currently recruiting patients at a single institution. Patients are 1:1 allocated to HFSRT or SRS using permuted block randomization. Affiliation to the treatment arm is solely blinded to the neuroradiologist assessing therapy response. HFSRT will be delivered with 6 - 7 x 5 Gy and SRS with 1 x 12-20 Gy, prescribed to the surrounding isodose, depending on cavity size and proximity to structures at risk. For SRS, doses do not exceed the maximum doses according to RTOG 90-05. Case number calculation was based on own institutional data on HFSRT (mean LC rate of 88% at 12 months) and data from large phase III trials on SRS (pooled mean LC rate of 66% at 12 months). Using a Chi-squared test of equal proportions (odds ratio = 1), setting test significance level (α) to 0.05, and allocating an equal number of patients to both treatment arms, 114 patients are needed to detect the superiority of HFSRT in terms of LC at 12 months (primary endpoint) with a power of at least 80%. Estimating a dropout rate of 10%, the case number was set to 126. The trial was registered with clinicaltrials.gov (NCT05160818). The first patient was enrolled in May 2021 and recruitment is ongoing. Patients with up to three resected brain metastases are considered for study participation. Further eligibility criteria are histologically confirmed solid tumor disease, resection cavity diameter ≤ 4 cm, consent to perform adjuvant radiotherapy by an interdisciplinary tumor board, completed wound healing, resection within the last six weeks at the time of study inclusion, age ≥ 18 years, KPS ≥ 60%, adequate contraceptive measures for fertile women / men and written informed consent. Patients are followed up clinically and with MRI at 6 weeks and 3, 6, 9 and 12 months after treatment. LC is assessed according to RANO-BM. Toxicity (CTCAE v4.03) is assessed as a secondary endpoint. The rather broad dose corridors allowed within the trial do justice to clinical reality, however, may represent a limitation of the trial. They are therefore addressed with a predefined subgroup analysis, as will be cavity size, among others. Participation of further study centers is desired. To the best of our knowledge, the SATURNUS trial is the only randomized phase III trial adequately powered to detect the superiority of HFSRT over SRS with regard to LC for resected brain metastases. RESULTS To be determined. CONCLUSION To be determined.
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Affiliation(s)
- M Waltenberger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - D Bernhardt
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - C Diehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - B Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - B Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
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Al Hussein Al Awamlh B, Wallis CJD, Diehl C, Barocas DA, Beskow LM. The lived experience of prostate cancer: 10-year survivor perspectives following contemporary treatment of localized prostate cancer. J Cancer Surviv 2023:10.1007/s11764-023-01381-6. [PMID: 37171717 DOI: 10.1007/s11764-023-01381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/10/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Studies relying on standardized instruments to measure patient-centered harms and benefits of cancer treatment may fail to capture important elements of the lived experience of cancer patients. Further, qualitative studies on the survivorship experience of men with localized prostate cancer (PCa) are limited. We sought to explore the early experience, long-term experience, and advice provided for others among long-term survivors of localized PCa. METHODS Semi-structured qualitative interviews with a subset (n = 66) of respondents to a survey of 10-year PCa survivors who underwent active surveillance, radical prostatectomy, or radiotherapy. Topics included early and long-term experiences and advice to other men and physicians. RESULTS Immediately after treatment, men were mostly satisfied with radiation and active surveillance due to remaining whole and avoiding surgical removal of the prostate. Meanwhile, men treated with surgery felt relieved by the removal of cancer. Some early negative perception was related to short-term anxiety, particularly among men who underwent active surveillance. Long-term experiences included accepting the trade-offs of urinary and sexual side effects with survival. Most men fared well financially, some had strengthened relationships, and many reported greater appreciation and compassion. Men provided essential advice to other men and physicians on the importance of gathering detailed information on treatments and establishing a strong relationship with physicians. CONCLUSIONS Long-term survivors of localized PCa generally do well by accepting the long-term effects of contemporary treatments, experiencing strengthened relationships, and developing a better overall life approach. IMPLICATIONS FOR CANCER SURVIVORS We provide useful perspectives and insights for men opting to use current-day treatments for localized PCa.
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Affiliation(s)
- Bashir Al Hussein Al Awamlh
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA.
| | | | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Medical Center North, Vanderbilt University Medical Center, 1161 21st Avenue South, A-1302, Nashville, TN, 37232, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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Shinall MC, Ely EW, Diehl C, Beskow LM. ASO Visual Abstract: Patient Perspectives on Perioperative Supportive Care Needs Surrounding Major Abdominal Operations for Cancer. Ann Surg Oncol 2023; 30:2606. [PMID: 36585534 DOI: 10.1245/s10434-022-12983-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Myrick C Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
- Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA.
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Allergy, Pulmonology, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Geriatrics Research Education and Clinical Center (GRECC), Nashville Veterans Affairs Medical Center, Nashville, TN, USA
| | - Carolyn Diehl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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Shinall MC, Ely EW, Diehl C, Beskow LM. Patient Perspectives on Perioperative Supportive Care Needs Surrounding Major Abdominal Operations for Cancer. Ann Surg Oncol 2023; 30:2597-2605. [PMID: 36463355 PMCID: PMC10184497 DOI: 10.1245/s10434-022-12895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/27/2022] [Indexed: 12/07/2022]
Abstract
PURPOSE The development of supportive care interventions delivered by surgeons for their patients is a major research priority. Designing such interventions requires understanding patients' supportive care needs for major operations. This qualitative analysis aimed to determine the supportive care needs of patients undergoing major abdominal operations for cancer. METHODS We conducted semi-structured interviews with a subset of participants in a randomized, controlled trial of a specialist palliative care intervention for patients undergoing abdominal resections for cancer (NCT03436290). Sampling was designed to balance the population by sex, age (older vs. younger than 65 years), and treatment group assignment (intervention vs. control). The interview guide was developed to elicit patient perceptions of their supportive care needs from diagnosis to the time of interview, about 1 month after their operation. Two coders used an iterative, inductive method to identify recurring themes in the interviews. RESULTS Analysis of interview transcripts revealed five primary themes: preoperative preparation, postoperative recovery, expectation setting, coordination of care, and provider characteristics. Cutting across these themes were patients' focus on time, timeliness, and timelines, as well as their desires for information both from their surgeons and other sources. Surgeons inspired trust through the quality of their communication and their responsiveness to questions. Patients were sensitive to perceived deviations from their expectations and spoke of the need to develop patience and to expect the unexpected. CONCLUSIONS Patients expressed several needs for supportive care that surgical teams can potentially address to improve the experience of major cancer surgery.
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Affiliation(s)
- Myrick C Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
- Section of Palliative Care, Vanderbilt University Medical Center, Nashville, TN, USA.
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA.
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Allergy, Pulmonology, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Geriatrics Research Education and Clinical Center (GRECC), Nashville Veterans Affairs Medical Center, Nashville, TN, USA
| | - Carolyn Diehl
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura M Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA
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Benedetti DJ, Hammack-Aviran CM, Diehl C, Beskow LM. Landscape of pediatric cancer treatment refusal and abandonment in the US: A qualitative study. Front Pediatr 2023; 10:1049661. [PMID: 36699305 PMCID: PMC9869139 DOI: 10.3389/fped.2022.1049661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
Objective To describe United States (US) pediatric oncologists' experiences with treatment refusal or abandonment, exploring types and frequency of decision-making conflicts, and their impact. Study design We conducted exploratory qualitative interviews of pediatric oncologists (n = 30) with experience caring for a pediatric patient who refused or abandoned curative treatment. Interviewees were recruited using convenience and nominated expert sampling, soliciting experiences from diverse geographic locations and institution sizes across the US. We analyzed transcripts using applied thematic analysis to identify and refine meaningful domains. Results Many oncologists reported multiple experiences with refusal and abandonment. Most anticipated case frequency would increase due to misinformation, particularly on the internet. Interviewees described cases of treatment refusal and abandonment, but also a wider variety of cases than previously described in existing publications, including cases involving: non-adherence; negotiations for different treatments; negotiations for complementary and alternative medicine; delayed treatment initiation; and refusal of a component of recommended therapy. Cases often involved multiple stages or types of conflicts. Recurring patient/family behaviors emerged: clear opposition to treatment from the outset; hesitancy about treatment despite initiating therapy; and psychosocial circumstances becoming an obstacle to treatment completion. Oncologists revealed substantial professional and personal repercussions of these cases. Conclusion Oncologist interviews highlight a broad range of conflicts, yielding a taxonomy of treatment refusal, non-adherence and abandonment (TRNA) that accounts for the heterogeneity of situations described. Cases' complexity and interrelatedness points to a functional model of TRNA that includes families' behaviors. This preliminary taxonomy and model warrant further research and examination to refine the model and generate strategies to prevent and mitigate TRNA.
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Affiliation(s)
- Daniel J. Benedetti
- Division of Hematology and Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Catherine M. Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Laura M. Beskow
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, United States
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Hammack-Aviran C, Eilmus A, Diehl C, Gottlieb KG, Gonzales G, Davis LK, Clayton EW. LGBTQ+ Perspectives on Conducting Genomic Research on Sexual Orientation and Gender Identity. Behav Genet 2022; 52:246-267. [PMID: 35614288 PMCID: PMC9132750 DOI: 10.1007/s10519-022-10105-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/03/2022] [Indexed: 11/30/2022]
Abstract
We conducted in-depth, semi-structured interviews with LGBTQ+-identified individuals (n = 31) to explore the range of LGBTQ+ perspectives on genomic research using either sexual orientation or gender identity (SOGI) data. Most interviewees presumed that research would confirm genetic contributions to sexual orientation and gender identity. Primary hopes for such confirmation included validating LGBTQ+ identities, improved access to and quality of healthcare and other resources, and increased acceptance in familial, socio-cultural, and political environments. Areas of concern included threats of pathologizing and medicalizing LGBTQ+ identities and experiences, undermining reproductive rights, gatekeeping of health or social systems, and malicious testing or misuse of genetic results, particularly for LGBTQ+ youth. Overall, interviewees were divided on the acceptability of genomic research investigating genetic contributions to sexual orientation and gender identity. Participants emphasized researchers' ethical obligations to LGBTQ+ individuals and endorsed engagement with LGBTQ+ communities throughout all aspects of genomic research using SOGI data.
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Affiliation(s)
- Catherine Hammack-Aviran
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | - Ayden Eilmus
- College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Diehl
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA
| | | | - Gilbert Gonzales
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lea K Davis
- Department of Medicine, Health and Society, Vanderbilt University, Nashville, TN, USA
| | - Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 2525 West End Ave., Suite 400, Nashville, TN, 37203, USA.
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Kessel KA, Deichl A, Gempt J, Meyer B, Posch C, Diehl C, Zimmer C, Combs SE. Outcomes after stereotactic radiosurgery of brain metastases in patients with malignant melanoma and validation of the melanoma molGPA. Clin Transl Oncol 2021; 23:2020-2029. [PMID: 33993415 PMCID: PMC8390419 DOI: 10.1007/s12094-021-02607-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Malignant melanoma is the third most common primary in the diagnosis of brain metastases. Stereotactic radiosurgery (SRS) is a well-established treatment option in limited brain disease. We analyzed outcomes of SRS with a particular focus on the graded prognostic assessment (GPA, melanoma molGPA), prognostic factors, and toxicity. METHODS We evaluated 173 brain metastases in 83 patients with malignant melanoma. All were treated with SRS median dose of 20 Gy prescribed to the 80 or 100% isodose line between 2002 and 2019. All patients were followed-up regularly, including contrast-enhanced brain imaging as well as clinical examination, initially 6 weeks after treatment, then in quarterly follow-up. RESULTS The median age was 61 years (range 27-80); 36 female and 47 male patients were treated. After a median follow-up of 5.7 months, median OS (overall survival) was 9.7 months 95%-KI 4.7-14.7). LC (local control) at 6 months, 12, 24 months was 89%, 86%, and 72%, respectively (median was not reached). Median DBC (distant brain control) was 8.2 months (95%-KI 4.7-11.7). For OS, a KPS ≥ 80%, a positive BRAF mutation status, a small PTV (planning target volume), the absence of extracranial metastases, as well as a GPA and melanoma molGPA > 2 were prognostic factors. In the MVA, a small PTV and a melanoma molGPA > 2 remained significant. CONCLUSION The present survival outcomes support the use of the disease-specific melanoma molGPA as reliable prognostic score. Favorable outcomes for SRS compared to other studies were observed. In the treatment of brain metastases of malignant melanoma patients, a multidisciplinary approach consisting of surgery, SRS, chemotherapy, and immunotherapy should be considered.
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Affiliation(s)
- K A Kessel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany
| | - A Deichl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.
| | - J Gempt
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Munich, Germany
| | - B Meyer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany.,Department of Neurosurgery, Technical University of Munich (TUM), Munich, Germany
| | - C Posch
- Department of Dermatology and Allergy, Technical University of Munich (TUM), Munich, Germany.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria
| | - C Diehl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany
| | - C Zimmer
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany.,Department of Neuroradiology, Technical University of Munich (TUM), Munich, Germany
| | - S E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), DKTK Partner Site Munich, Munich, Germany
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Fegert JM, Diehl C, Leyendecker B, Hahlweg K, Prayon-Blum V. Psychosocial problems in traumatized refugee families: overview of risks and some recommendations for support services. Child Adolesc Psychiatry Ment Health 2018; 12:5. [PMID: 29344083 PMCID: PMC5765601 DOI: 10.1186/s13034-017-0210-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 12/29/2022] Open
Abstract
This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures.
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Affiliation(s)
- J. M. Fegert
- grid.410712.1Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstrasse 5, 89075 Ulm, Germany
| | - C. Diehl
- 0000 0001 0658 7699grid.9811.1University of Konstanz, Konstanz, Germany
| | - B. Leyendecker
- 0000 0004 0490 981Xgrid.5570.7Ruhr-Universitaet Bochum, Bochum, Germany
| | - K. Hahlweg
- 0000 0001 1090 0254grid.6738.aTechnische Universitaet Braunschweig, Braunschweig, Germany
| | - V. Prayon-Blum
- grid.410712.1Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, Steinhoevelstrasse 5, 89075 Ulm, Germany
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Britschgi C, Diehl C, Rechsteiner M, Valtcheva N, Freiberger S, Wong C, Curioni-Fontecedro A, Siebenhüner A, Christiansen A, Velizheva N, Zhong Q, Wagner U, Stahel R, Moch H, Wild P. Implications of routine NGS testing for daily clinical practice – the Zurich experience with the OFA panel. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hillger JM, Diehl C, van Spronsen E, Boomsma DI, Slagboom PE, Heitman LH, IJzerman AP. Getting personal: Endogenous adenosine receptor signaling in lymphoblastoid cell lines. Biochem Pharmacol 2016; 115:114-22. [PMID: 27297283 DOI: 10.1016/j.bcp.2016.06.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022]
Abstract
Genetic differences between individuals that affect drug action form a challenge in drug therapy. Many drugs target G protein-coupled receptors (GPCRs), and a number of receptor variants have been noted to impact drug efficacy. This, however, has never been addressed in a systematic way, and, hence, we studied real-life genetic variation of receptor function in personalized cell lines. As a showcase we studied adenosine A2A receptor (A2AR) signaling in lymphoblastoid cell lines (LCLs) derived from a family of four from the Netherlands Twin Register (NTR), using a non-invasive label-free cellular assay. The potency of a partial agonist differed significantly for one individual. Genotype comparison revealed differences in two intron SNPs including rs2236624, which has been associated with caffeine-induced sleep disorders. While further validation is needed to confirm genotype-specific effects, this set-up clearly demonstrated that LCLs are a suitable model system to study genetic influences on A2AR response in particular and GPCR responses in general.
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Affiliation(s)
- J M Hillger
- Division of Medicinal Chemistry, LACDR, Leiden University, The Netherlands
| | - C Diehl
- Division of Medicinal Chemistry, LACDR, Leiden University, The Netherlands
| | - E van Spronsen
- Division of Medicinal Chemistry, LACDR, Leiden University, The Netherlands
| | - D I Boomsma
- Department of Biological Psychology, VU University Amsterdam, The Netherlands
| | - P E Slagboom
- Section of Molecular Epidemiology, Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, The Netherlands
| | - L H Heitman
- Division of Medicinal Chemistry, LACDR, Leiden University, The Netherlands
| | - A P IJzerman
- Division of Medicinal Chemistry, LACDR, Leiden University, The Netherlands.
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Adeberg S, Kehle D, Mohr A, Rieken S, Bostel T, Koelsche C, Diehl C, Debus J. EP-1331: Diabetes and metformin influence survival in glioblastoma patients. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diehl C, Wendt K, Lindahl AO, Andersson P, Hanstorp D. Ion optical design of a collinear laser-negative ion beam apparatus. Rev Sci Instrum 2011; 82:053302. [PMID: 21639495 DOI: 10.1063/1.3587617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
An apparatus for photodetachment studies on atomic and molecular negative ions of medium up to heavy mass (M ≃ 500) has been designed and constructed. Laser and ion beams are merged in the apparatus in a collinear geometry and atoms, neutral molecules and negative ions are detected in the forward direction. The ion optical design and the components used to optimize the mass resolution and the transmission through the extended field-free interaction region are described. A 90° sector field magnet with 50 cm bending radius in combination with two slits is used for mass dispersion providing a resolution of M∕ΔM≅800 for molecular ions and M∕ΔM≅400 for atomic ions. The difference in mass resolution for atomic and molecular ions is attributed to different energy distributions of the sputtered ions. With 1 mm slits, transmission from the source through the interaction region to the final ion detector was determined to be about 0.14%.
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Affiliation(s)
- C Diehl
- Institut für Physik, Johannes Gutenberg-Universität, Mainz, D-55099 Mainz, Germany
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Maleszka A, Kleikamp G, Diehl C, Gummert J. A huge right atrial tumor as primary manifestation of hepatocellular carcinoma. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kracht J, Bachert I, Diehl C, Kämmerling S, Lüchtenberg M, Zubcov A, Simonsz H, Fronius M. Elektronisch erfasste Okklusionstherapie bei über 7-jährigen Amblyopen: Visusanstieg noch nach mehr als 4 Monaten? Klin Monbl Augenheilkd 2010; 227:774-81. [DOI: 10.1055/s-0029-1245752] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sanclemente G, Garcia JJ, Zuleta JJ, Diehl C, Correa C, Falabella R. A double-blind, randomized trial of 0.05% betamethasone vs. topical catalase/dismutase superoxide in vitiligo. J Eur Acad Dermatol Venereol 2008; 22:1359-64. [DOI: 10.1111/j.1468-3083.2008.02839.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Diehl C. Standardization across multiple sites. Clin Lab Manage Rev 1998; 12:347-52. [PMID: 10185014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Standardizing products, procedures, and processes in clinical departments across multiple sites has significant potential for improving clinical outcomes, enhancing financial savings, and simplifying management processes. This is true whether a network of owned hospitals is working toward a full-scale clinical integration or a group of community hospitals is collaborating to gain cost efficiencies. By developing a functional team and designing a relatively simple program, the results can be very rewarding. The author describes some of the basic principles in designing a standardization program and cites some examples of successful programs as well as listing some pitfalls to be avoided along the way.
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Affiliation(s)
- C Diehl
- MDS Laboratory Services, USA
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Oberhoff M, Baumbach A, Hermann T, Diehl C, Maier R, Athanasiadis A, Herdeg C, Bohnet A, Haase KK, Voelker W, Baildon R, Veldhof S, Karsch KR. Local and systemic delivery of low molecular weight heparin following PTCA: acute results and 6-month follow-up of the initial clinical experience with the porous balloon (PILOT-study). Preliminary Investigation of Local Therapy Using Porous PTCA Balloons. Cathet Cardiovasc Diagn 1998; 44:267-74. [PMID: 9676794 DOI: 10.1002/(sici)1097-0304(199807)44:3<267::aid-ccd4>3.0.co;2-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this study was to assess safety and feasibility of intracoronary delivery of reviparin using a porous balloon following percutaneous transluminal coronary angioplasty. The 2.7 mm porous balloon used in this study had 35 holes arranged in a spiral pattern. Eighteen patients (male n = 10, female n = 8, age 63 +/- 9 years) undergoing successful PTCA in coronary arteries with a vessel diameter of 2.5 to 3.0 mm determined by online QCA (LAD = 11, RCX = 3, RCA = 4) were included. They received a bolus of 7,000 anti-Xa-IU reviparin followed by local delivery of 1,500 anti-Xa-IU in 4 ml with an injection pressure of 2 atm. The patients received additionally 10500 anti-Xa-units intravenously during the following 24 hours and a daily dose of 7000 anti-Xa-units reviparin subcutaneously for the following 28 days. Angiograms were obtained before and after PTCA, directly after local delivery, at 24 hours postintervention and after 6 months. The primary success rate was 100%. Quantitative coronary angiography showed a minimum luminal diameter of 0.42 +/- 0.14 mm before PTCA, 1.87 +/- 0.45 after PTCA, 1.67 +/- 0.43 after LDD, 1.63 +/- 0.46 after 24 hours, and 1.06 +/- 0.6 after 6 months. Angiographic follow-up was obtained in all patients. No major complications occurred during the 6-month follow-up period. The angiographic restenosis rate was 28% (5/18) at follow-up. This study demonstrates safety and feasibility of local intracoronary delivery of reviparin with a porous balloon following PTCA even in smaller diameter coronary arteries.
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Affiliation(s)
- M Oberhoff
- Department of Medicine, University of Tübingen, Germany.
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Jain K, Yang H, Asina SK, Patel SG, Desai J, Diehl C, Stenzel K, Smith BH, Rubin AL. Long-term preservation of islets of Langerhans in hydrophilic macrobeads. Transplantation 1996; 61:532-6. [PMID: 8610376 DOI: 10.1097/00007890-199602270-00003] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Several obstacles have hindered the successful transplantation of islets of Langerhans to human patients in efforts to cure type I diabetes mellitus. One problem is the necessity for short- and long-term storage of islets after isolation and before transplantation. Current long-term storage methods, such as incubation in a physiological medium and cryopreservation, are suboptimal, resulting in significant loss of viable islet mass or function. Better storage methods are needed. In this study we examined the long-term storage of rat islets in macrobeads composed of agarose and collagen. Islets isolated from Wistar-Furth rats were placed into macrobeads (1000 islets/macrobead) and maintained in culture for periods of up to 189 days at 37 degrees C. Insulin released from the cultured macrobeads remained constant for periods of at least 154 days. In one group, insulin release was 1050 mU/24 hr/4 beads on day 3 and 1040 mU/24 hr/4 beads on day 154. In another group, insuling release was 1305 Xenotransplantation of Wistar Furth islet macrobeads, stored for 10 to 112 days at 37 degrees C, degrees C into 42 B6AF/1 mice with streptozotocin-induced diabetes resulted in a return to euglycemia in the recipients within 24 hr. Thereafter, euglycemia was maintained for more than 100 days in 32/42 of the recipients, and removal of the macrobeads caused a return to hyperglycemia within 48 hr in all animals. In addition, a group of 7 mice receiving macrobeads containing 1000 islets stored for 84 days had normal glucose tolerance tests (compared with those of 7 nontreated, nontransplanted mice with streptozotocin-induced diabetes and 7 normal mice), demonstrating that the islets in the macrobeads were functioning as they would in an intact pancreas. Finally, 5 macrobeads transplanted after initial storage of 112 days, removed from the first recipient after 100 days or more, stored again for 4 days in vitro, and retransplanted into 5 other diabetic mice also restored and maintained euglycemia for at least 45 days. Our results indicate that collagen-agarose macrobeads are capable of preserving rat pancreatic islets for extended periods without loss of in vitro insulin release capability or ability to achieve and maintain euglycemia in vivo. As such they should be useful for human islet transplantation efforts.
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Affiliation(s)
- K Jain
- Islet Purification Laboratory, Rogosin Institute, New York 10021, USA
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Jain K, Yang H, Cai BR, Haque B, Hurvitz AI, Diehl C, Miyata T, Smith BH, Stenzel K, Suthanthiran M. Retrievable, replaceable, macroencapsulated pancreatic islet xenografts. Long-term engraftment without immunosuppression. Transplantation 1995; 59:319-24. [PMID: 7871558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prevention of rejection and prolongation of graft survival are critical to achieving successful islet cell transplantation. Various techniques have been utilized to prolong graft survival. Recently, protection of pancreatic islets from host immune mechanisms by isolating the islets in artificial membranes has emerged as an attractive alternative to the use of immunosuppression. In this Rapid Communication, we describe a novel method for macroencapsulation of rat islets in hydrophilic macrobeads made with various combinations of agarose, collagen, and Gelfoam. Encapsulated xenotypic islets were placed intraperitoneally in mice in which diabetes was induced by streptozotocin. The encapsulated xenografts maintained normoglycemia > 170 days. Recipients mice had normal glucose tolerance tests, which indicates that the islets in the macrobeads were functioning as they would in an intact pancreas. Macrobeads retrieved up to 103 days after transplantation showed no evidence of tissue reaction or local inflammation. These retrieved macrobeads could also be retransplanted and replaced. Our studies indicate that the agarose-collagen/Gelfoam macrobeads we have developed serve both to protect islet xenografts from rejection and to provide a microenvironment in which the islets maintain and support their normal function in vivo. Because they may be retrieved after implantation and replaced, these macrobeads may be suitable for human clinical islet cell xenotransplantation.
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Affiliation(s)
- K Jain
- Rogosin Institute, Department of Biochemistry and Surgery, New York Hospital-Cornell Medical Center, New York
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Abstract
Caring for brain-dead pregnant women is a new critical care challenge. Rather than the usual life/death situations involving catastrophic events, critical care nurses have the added burden of caring for a life in suspension to maintain the viability of the fetus. Nurses struggle with keeping the brain-dead patient alive and yet know that as soon as the infant is delivered the mother will be allowed to die. These authors use interviews with clinical nurses to show how they used the coping strategy of creating meaning to successfully cope with this difficult situation.
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Bernice J, Diehl C, Grenon EB, McLister E, Stahl SM. Networking with our colleagues. Clin Lab Manage Rev 1990; 4:124-8. [PMID: 10104292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Diehl C. [Health and what keeps youth from attaining it]. Osterr Krankenpflegez 1985; 38:149-50. [PMID: 3847854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Diehl C. [Health--and what keeps youth from it]. Krankenpflege (Frankf) 1985; 39:110-1. [PMID: 3923256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Diehl C. Atomgewicht des Lithiums. Anal Bioanal Chem 1862. [DOI: 10.1007/bf01430027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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