Effectiveness, safety and impact of guselkumab on sexuality and perceived stigmatization in patients with psoriasis in routine clinical practice: Week 28 results from the prospective German multicentre G-EPOSS study

BACKGROUND

G-EPOSS is a prospective, non-interventional, German multicentre study of patients with moderate-to-severe plaque psoriasis receiving guselkumab, a therapeutic monoclonal antibody targeting interleukin-23, in a real-world setting.

OBJECTIVES

The objective of the study was to evaluate the effectiveness and safety of guselkumab, including its impact on skin, health-related quality of life (HRQoL), sexuality, and perceived stigmatization.

METHODS

Patients (≥18 years old) received guselkumab per routine clinical practice. The primary endpoint was the proportion of patients achieving absolute Psoriasis Area and Severity Index (PASI) ≤ 3 at Week (W)28. Secondary endpoint assessments over 28 weeks included the Nail Psoriasis Severity Index (NAPSI), anogenital Physician's Global Assessment (aPGA), and Dermatology Life Quality Index (DLQI). Sexuality and perceived stigmatization were assessed by patients using the Relationship and Sexuality Scale (RSS) and Perceived Stigmatization Questionnaire (PSQ), respectively.

RESULTS

Overall, 293 patients were included in the evaluable set population. Mean age and disease duration were 45.6 and 17.6 years, respectively. At baseline, mean PASI, aPGA and DLQI scores were 15.3, 2.7 and 11.3, respectively. In total, 25.9% of patients had received a prior biologic. Overall, 83.0% of patients achieved PASI ≤ 3, and 56.2%/35.1% achieved PASI ≤ 1/PASI = 0, respectively, at W28. Among those with NAPSI ≥ 1 and aPGA ≥ 1 at baseline, NAPSI = 0 and aPGA = 0 were achieved by 39.2% and 61.1% of patients, respectively, and 61.4% of patients achieved DLQI 0-1 at W28. Improvements were observed over 28 weeks across individual items of the DLQI, RSS and PSQ, indicating improved HRQoL and sex life, and decreased perceived stigmatization. Based on DLQI Question (Q)9, 53.6% of patients experienced sexual difficulties at baseline, which decreased to 12.1% at W28. DLQI Q9 responses were consistent with RSS item responses, highlighting DLQI Q9 as a sentinel for sexual impairment.

CONCLUSIONS

Guselkumab improved overall skin symptoms and HRQoL in patients with psoriasis and decreased sexual impairment and perceived stigmatization. No new safety signals were observed.

STUDY CODE

CNTO1959PSO4008.

What can we do about patients presenting with myeloma and severe renal failure? Observations from the UK MERIT plasma exchange trial

Myeloma patients presenting with renal failure continue to have a poor prognosis despite significant advances in anti-myeloma therapy. MERIT was a randomised clinical trial (RCT), set up to evaluate if mechanical reduction of elevated free light chain levels (FLC) would result in clinical benefit. Completion of the planned seven plasma exchanges (PEs) in the first 14 days failed to show, for the exchange group, a greater reduction in FLC or any improvement in dialysis independence at 100 days or subsequently. To improve prognosis for these patients requires earlier diagnosis and prompt anti-myeloma therapy with effectiveness guided by frequent FLC monitoring.

New Constraint on the Local Relic Neutrino Background Overdensity with the First KATRIN Data Runs

We report on the direct search for cosmic relic neutrinos using data acquired during the first two science campaigns of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity molecular tritium gas source are analyzed by a high-resolution MAC-E filter around the end point at 18.57 keV. The analysis is sensitive to a local relic neutrino overdensity ratio of η<9.7×10^{10}/α (1.1×10^{11}/α) at a 90% (95%) confidence level with α=1 (0.5) for Majorana (Dirac) neutrinos. A fit of the integrated electron spectrum over a narrow interval around the end point accounting for relic neutrino captures in the tritium source reveals no significant overdensity. This work improves the results obtained by the previous neutrino mass experiments at Los Alamos and Troitsk. We furthermore update the projected final sensitivity of the KATRIN experiment to η<1×10^{10}/α at 90% confidence level, by relying on updated operational conditions.

Bound on 3+1 Active-Sterile Neutrino Mixing from the First Four-Week Science Run of KATRIN

We report on the light sterile neutrino search from the first four-week science run of the KATRIN experiment in 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are analyzed by a high-resolution MAC-E filter down to 40 eV below the endpoint at 18.57 keV. We consider the framework with three active neutrinos and one sterile neutrino. The analysis is sensitive to the mass, m_{4}, of the fourth mass state for m_{4}^{2}≲1000  eV^{2} and to active-to-sterile neutrino mixing down to |U_{e4}|^{2}≳2×10^{-2}. No significant spectral distortion is observed and exclusion bounds on the sterile mass and mixing are reported. These new limits supersede the Mainz results for m_{4}^{2}≲1000  eV^{2} and improve the Troitsk bound for m_{4}^{2}<30  eV^{2}. The reactor and gallium anomalies are constrained for 100<Δm_{41}^{2}<1000  eV^{2}.

Improved Upper Limit on the Neutrino Mass from a Direct Kinematic Method by KATRIN

We report on the neutrino mass measurement result from the first four-week science run of the Karlsruhe Tritium Neutrino experiment KATRIN in spring 2019. Beta-decay electrons from a high-purity gaseous molecular tritium source are energy analyzed by a high-resolution MAC-E filter. A fit of the integrated electron spectrum over a narrow interval around the kinematic end point at 18.57 keV gives an effective neutrino mass square value of (-1.0_{-1.1}^{+0.9})  eV^{2}. From this, we derive an upper limit of 1.1 eV (90% confidence level) on the absolute mass scale of neutrinos. This value coincides with the KATRIN sensitivity. It improves upon previous mass limits from kinematic measurements by almost a factor of 2 and provides model-independent input to cosmological studies of structure formation.

Clinical ethics consultations in psychiatric compared to non-psychiatric medical settings: characteristics and outcomes

BACKGROUND

In the recent years clinical ethics consultations (CEC) received an increasing attention not only in patients with medical conditions but also in those with mental disorders. However, the systematic and empirical knowledge is still small. The aim of this observational study was to investigate whether CECs differ between psychiatric and medical hospital inpatients regarding ethical issues, goals, characteristics, processes, and outcomes.

METHODS

This is a retrospective and in parts prospective analysis of a semi-structured CEC approach provided by the CEC service at a large German general hospital between January 2006 and June 2015.

RESULTS

A total of 259 CECs in three inpatient settings were investigated, i.e. intensive care units (ICU, 43.6%), low care units (LCU, 33.6%), and psychiatric care units (PCU, 22.8%). In all groups, most ethical issues addressed treatment intensity (80.6%) and resulted in over 93% in participants' agreement on final ethical recommendations as well as in high implementation rates (>89%). However, we found significant group differences: In PCUs patients participated more often in the CEC (p < .001), the number of all participants was higher (p < .001), CECs were more time expensive (p < .001), and more recommendations focused on interventions against the patients' declared intention (37.7% versus 0%) than in the other groups.

DISCUSSION

In spite of different clinical characteristics and ethical issues between patients and settings, consensus and implementation of the CEC recommendation could be achieved at a high rate in all groups. There are substantial differences regarding goals, participation of patients, and processes. It is worth considering adapting the CEC to the special needs in psychiatric settings, especially under the aspect of the patients' perspective and involvement.

Ist die Beweglichkeit der HWS bei Patienten mit chronischem Nackenschmerz eingeschränkt?

Hintergrund: Die Untersuchung des Bewegungsumfangs ist fester Bestandteil des Assessments bei Patienten mit Nackenschmerz. Bewegungseinschränkungen gelten als sicheres Zeichen für akute Schmerzzustände. Bei chronischem Nackenschmerz ist das Vorhandensein von Bewegungseinschränkungen jedoch fraglich.

Ziel: Die vorliegende Erhebung untersuchte, ob Patienten mit chronischem Nackenschmerz Bewegungseinschränkungen aufweisen.

Methode: 60 gesunde Probanden und 60 Patienten mit chronischem Nackenschmerz wurden mittels Ultraschalltopometrie während zyklischer Bewegungen der HWS bezüglich des Bewegungsumfangs untersucht und die Mittelwerte beider Gruppen auf signifikante Unterschiede überprüft. Ferner erfolgte die Klassifikation der gemessenen Bewegungsumfänge anhand geschlechts- und altersspezifischer Normwerte als normal, hypermobil oder hypomobil. Für die Validität des Befundes „hypomobil“ in Bezug auf die Erkennung des chronischen Nackenschmerzes wurden die Sensitivität, die Spezifität sowie die positive (LR+) und die negative Likelihood Ratio (LR–) ermittelt.

Ergebnisse: Die durchschnittlichen Bewegungsumfänge beider Gruppen unterschieden sich in alle Richtungen signifikant. Im Vergleich zu den Normwerten wiesen mehr als drei Viertel der Teilnehmer beider Gruppen eine normale Beweglichkeit auf. Die Sensitivität des Kriteriums „Hypomobilität“ lag bei maximal 0,23, die Spezifität bei über 0,9, die LR+ bei maximal 0,93 und der niedrigste Wert der LR– bei 0,65.

Schlussfolgerung: Beim chronischen Nackenschmerz ist das Bewegungsausmaß der HWS nicht vermindert. Für das Assessment fehlt ein objektiver Parameter, der mit psychosozialen Variablen korreliert und von Physiotherapeuten gemessen werden kann.

Prenatal and adult androgen activities in alcohol dependence

OBJECTIVE

Alcohol dependence is more prevalent in men than in women. The evidence for how prenatal and adult androgens influence alcohol dependence is limited. We investigated the effects of prenatal and adult androgen activity on alcohol dependence. Moreover, we studied how the behaviours of pregnant women affect their children's prenatal androgen load.

METHOD

We quantified prenatal androgen markers (e.g., second-to-fourth finger length ratio [2D : 4D]) and blood androgens in 200 early-abstinent alcohol-dependent in-patients and 240 controls (2013-2015, including a 12-month follow-up). We also surveyed 134 women during pregnancy (2005-2007) and measured the 2D : 4D of their children (2013-2016).

RESULTS

The prenatal androgen loads were higher in the male alcohol-dependent patients compared to the controls (lower 2D : 4D, P = 0.004) and correlated positively with the patients' liver transaminase activities (P < 0.001) and alcohol withdrawal severity (P = 0.019). Higher prenatal androgen loads and increasing androgen levels during withdrawal predicted earlier and more frequent 12-month hospital readmission in alcohol-dependent patients (P < 0.005). Moreover, stress levels (P = 0.002), alcohol (P = 0.010) and tobacco consumption (P = 0.017), and lifetime stressors (P = 0.019) of women during pregnancy related positively to their children's prenatal androgen loads (lower 2D : 4D).

CONCLUSION

Androgen activities in alcohol-dependent patients and behaviours of pregnant women represent novel preventive and therapeutic targets of alcohol dependence.

Abstract MIP-071: TARGETING A CHEMORESISTANT OVARIAN CANCER CELL POPULATION VIA THE CARBOHYDRATE ANTIGEN SIALYL TN

Key words: Sialyl Tn, drug resistance, antibody-drug conjugates, cancer stem cells

OBJECTIVES: A successful therapeutic strategy for ovarian cancer will require direct targeting of inherently chemoresistant tumor cells which are comprised in part of cancer stem cells (CSCs) that survive current cytotoxic treatment regimes and drive tumor resurgence. The sialyl-Tn (STn) antigen is a carbohydrate moiety present on tumor cells but rarely seen in normal adult tissue. Importantly, STn has been shown to be present on CSCs in pancreatic, colon, and gastric malignancies. Our objective was to assess the expression of STn and the known CSC marker CD133 in human ovarian cancer (OvCa) cell lines and primary serous carcinomas, and evaluate the ability of STn+ and STn- cells to both grow in an anchorage independent manner and survive standard-of-care cytotoxic therapy. Furthermore, we sought to assess the effect of murine and humanized α -STn antibody-drug conjugates (ADCs) on OvCa cells in vitro and tumor viability in vivo.

METHODS: STn and CD133 expression in established OvCa cell lines was analyzed by flow cytometry. STn-CD133-, STn+CD133-, STn-CD133+ and STn+CD133+ cells were purified from OVCAR3 and OVCAR4 by FACS, plated in soft agar, and incubated for 21 days. Colony forming efficiency of each sub-population was calculated. Unsorted cells were treated in vitro with either murine α -STn-monomethyl auristatin E (MMAE) ADC or vehicle control and cell viability was assessed by MTT assay. Subsequently, cells were treated in vitro with α -STn-MMAE, paclitaxel and carboplatin, or appropriate controls, and the profile of cells surviving 72 hours post-treatment was determined by flow cytometric analysis. Finally, OVCAR3-derived mouse xenografts were treated with murine and humanized α-STn-MMAE, unconjugated mAbs alone, and vehicle control. Mice were assessed regularly for tumor growth and cytotoxic effects.

RESULTS: In the OvCa cell lines OV90, OVCAR3 and OVCAR4, when grown in traditional 2D culture, STn+ cells comprised 98.4%, 40.0%, and 26.4% of the total cell population, respectively. In each of these cell lines, we readily detected STn+CD133+ sub-populations suggesting that STn is expressed on CD133+ ovarian CSCs. Colony formation assays analyzing FACS-purified STn-CD133-, STn+CD133-, STn-CD133+ and STn+ CD133+ sub-populations suggest that STn expression correlates with anchorage independent growth, a characteristic of cell stemness. Paclitaxel and carboplatin treatment in vitro significantly increased the proportion of STn+ and CD133+ cells, demonstrating the chemoresistant characteristics of these cells. Treatment with the murine α-STn-MMAE ADCs reduced the viability of OvCa cell lines in vitro in a dose-dependent manner. Treatment with murine and humanized α -STn- MMAE antibodies in vivo reduced tumor volumes, whereas vehicle treatment did not impede tumor growth. Interestingly, the unconjugated antibody also had a modest negative impact on tumor volume.

CONCLUSION: A novel, highly specific STn antibody identifies the STn antigen in OvCa cell lines and patient samples. STn+ and CD133+ cells demonstrate stem-like characteristics such as anchorage-independent growth and chemoresistance. STn ADCs decreased cell viability in vitro and reduced tumor volumes in vivo, suggesting that specific therapeutic targeting of STn in ovarian tumors may be an effective clinical strategy to eliminate quiescent CSCs.

Citation Format: B.R. Rueda, K. Starbuck, D. Eavarone, J. Prendergast, J. Stein, R. Foster, J. Behrens. TARGETING A CHEMORESISTANT OVARIAN CANCER CELL POPULATION VIA THE CARBOHYDRATE ANTIGEN SIALYL TN [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr MIP-071.

Hand Hygiene Training and Its Impact on the Knowledge of Undergraduate Nursing Students in Kosovo

BACKGROUND: Hand hygiene (HH) performing is a must in health care settings because it affects the human lives. Health Care Workers (HCW) must be aware and be trained continuously as regards hand hygiene.AIM: The aim of this article was to evaluate and compare the knowledge before and after an educational training of undergraduate nursing students at an educational institution in Pristine, Kosovo.METHODS: A pre- post survey was conducted in February 2016 at an educational institution in Pristine, Kosovo. The World Health Organization (WHO) questionnaire for hand hygiene knowledge of Health Care Workers (HCW) was used to collect the data.RESULTS: From a total of 100 students, only 13 (13 %) were men and 87 (87%) were women. Their ages ranged between 18-23 years old. Only 55 (55 %) had poor knowledge level, 42 (42%) had moderate knowledge level and only 3 (3%) had good knowledge about HH practices before the training and after the training only 1 (1%) participant was found with poor knowledge, 61 (61%) moderate knowledge and 38 (38 %) good knowledge. The training had a significant impact on the acquisition of HH’ knowledge. This was shown by the significant difference between the total points before and after the training (p <0.001).CONCLUCION: The training should be done consistently and be part of the nursing school curriculum, maintaining a satisfactory level of knowledge about hand hygiene as these students in a near future will face with Hand Hygiene (HH) issues in their daily clinical work.

New computational methods in tsunami science

Tsunamis are rare events with severe consequences. This generates a high demand on accurate simulation results for planning and risk assessment purposes because of the low availability of actual data from historic events. On the other hand, validation of simulation tools becomes very difficult with such a low amount of real-world data. Tsunami phenomena involve a large span of spatial and temporal scales-from ocean basin scales of [Formula: see text] to local coastal wave interactions of [Formula: see text] or even [Formula: see text], or from resonating wave phenomena with durations of [Formula: see text] to rupture with time periods of [Formula: see text]. The scale gap of five orders of magnitude in each dimension makes accurate modelling very demanding, with a number of approaches being taken to work around the impossibility of direct numerical simulations. Along with the mentioned multi-scale characteristic, the tsunami wave has a multitude of different phases, corresponding to different wave regimes and associated equation sets. While in the deep ocean, wave propagation can be approximated relatively accurately by linear shallow-water theory, the transition to a bore or solitary wave train in shelf areas and then into a breaking wave in coastal regions demands appropriate mathematical and numerical treatments. The short duration and unpredictability of tsunami events pose another challenging requirement to tsunami simulation approaches. An accurate forecast is sought within seconds with very limited data available. Thus, efficiency in numerical solution processes and at the same time the consideration of uncertainty play a big role in tsunami modelling applied for forecasting purposes.

[Appraisal of Educational Programmes and Qualifications of Health Occupations/Professions: A European Comparison - Main Results and Conclusions]

INTRODUCTION

This is about some results of a study called "Appraisal of the educational programmes and qualifications of health professions: a European Comparison" (in short: GesinE). It was carried out in the years 2009-2013, commissioned by the BMBF and supported by the BIBB. It is focussed on Germany, France, Great Britain, the Netherlands and Austria. The objectives have been (i) an inventory and comparative international synoptic presentation of education programmes of 16 health professions, (ii) a comparative international qualification analysis for the professions of radiographer, physiotherapist and nurse and (iii) the exposure of key aspects of the health-care and education systems in the compared countries.

METHODS

This is a comparative multi-sectional study for which a mixed methods approach with qualitative and quantitative elements was used.

RESULTS

According to the results of this study it is necessary that current qualification paths and competence profiles of the health professions are developed continuously in Germany. In this process the German education and the secondary education sector should not be underrated. At the same time the results suggest that there are advantages in some aspects in the academic education (which is the norm for most of the analysed professions in the surveyed countries) compared to the existing education programmes in the secondary sector. This in particular applies to the competence for finding and transferring scientific knowledge into practice and for implementing reflected processes for decision making.

CONCLUSIONS

The results improve the basis of the current debate in Germany about the development and reorganisation of the profiles of health professions and their qualification in a European context.

[The body concept for prostate carcinoma patients. Development and testing of a questionnaire which ascertains uro-oncological patients' attitudes to their own bodies under the influence of surgery-conditioned consequences]

BACKGROUND

The aim of this study is the construction of a questionnaire which determines uro-oncological patients' attitudes to their own bodies. The questionnaire will be tested by means of psychometric criteria for suitability. In this way, the emotional-affective and perceptual--cognitive characteristics of the body concept will be detected more effectively.

PARTICIPANTS AND METHODS

For the construction, 12 interviews with patients were conducted and items from four body concept questionnaires were analysed. Subsequently, a draft version, containing 133 items, was written. A total of 305 participants (PCa n=205; healthy n=100) were questioned in 2 studies. Thereafter the suitability of the items could be checked by psychometric and factor analytical criteria.

RESULTS

The psychometric testing of the statements led to a selection of the items. 40 items could be established as applicable and were therefore accepted for the final questionnaire.

CONCLUSION

The indentified scales show good psychometric characteristics and also differentiate between the healthy and the clinical samples. Preliminary analyses prove the validity of the scales, although this should be subjected to further testing for assurance.

[Relevance of personal contextual factors of the ICF for use in practical social medicine and rehabilitation]

Personal contextual factors play an essential part in the model of the International Classification of Functioning, Disability and Health (ICF). The WHO has not yet classified personal factors for global use although they impact on the functioning of persons positively or negatively. In 2010, the ICF working group of the German Society of Social Medicine and Prevention (DGSMP) presented a proposal for the classification of personal factors into 72 categories previously arranged in 6 chapters. Now a positioning paper has been added in order to stimulate a discussion about the fourth component of the ICF, to contribute towards a broader and common understanding about the nature of personal factors and to incite a dialogue among all those involved in health care as well as those people with or with-out health problems in order to gain a comprehensive perspective about a person's condition.

[Management documentation of therapeutic units on inpatient treatment for people with dementia--does it allow conclusion to be drawn them about inpatient services? An exploratory analysis]

BACKGROUND

Against the background of the continuously growing incidence rates of gerontopsychiatric disorders, their economic dimen-sions, and the effects on persons affected as well as their social environments, the present study focuses on an analysis of the services provided in acute psychiatric care settings for patients with dementia. RESULTS are based on secondary data.

AIM OF THE STUDY

We aim to compare therapeutic service units of different clusters of occupational groups (physicians/psychologists, nurses/special therapists) for the ICD-10 diagnostic groups F00-F03 and G30 in the years 2010 (starting with July) and 2011. Main research question is how many patients are mappable with 'therapeutic units' (Therapieeinheiten, TE) of the operation and procedures catalogue (OPS).

METHODS

The present study is based on an analysis of the §21 KHEntgG data record of 35 acute psychiatric facilities. Data collection took place within the project "Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)", "Supply indicators for psychiatric and psychosomatic settings". The data record implies statewide data of specialised hospitals, university hospitals and departments of psychiatry of the Federal Republic of Germany.

RESULTS

In total, 5 111 cases were included in the analysis. Nurses and special therapists carried out significantly more therapeutic units in the main diagnoses groups (F01, F03 and G30) and the care groups (regular vs. intensive) than physicians and psychologists (p<0.05). It was not possible to map all patients with the use of therapeutic units (G30 78.8%, F01 83.4%, F03 81.2%). Mapping of patients was significantly higher in the intensive care compared to regular care in both occupational clusters (p<0.05).

CONCLUSIONS

We demonstrated that the "therapeutic units" of the OPS codes are now used in the routine data (§21 KHEntgG), and that they are able to portray relevant aspects of non-medication therapeutic service. The present study provides a preliminary/exploratory overview on the services provided, mapped by therapeutic units. Future research should focus on the overlap between the category "therapeutic" units and the services actually provided.

[Therapeutic nursing: a systematic review]

BACKGROUND

For some years therapeutic service catalogues have been established in medical rehabilitation which have broadened our previous understanding of nursing actions. Currently, therapeutic nursing plays a prominent role in neurological early rehabilitation because the operations and procedures coding system (OPS) 8-552 within the DRG-System (Diagnosis Related Groups) states that therapeutic nursing must be carried out by specially trained nursing personnel. This requirement leads to inconsistencies in nursing practice and the medical service of the health insurance (MDK) since a definition of therapeutic nursing is lacking. A previous review of therapeutic nursing in 2003 focused primarily on the development of the therapeutic nursing role, but not on therapeutic nursing itself. The following article contains the first systematic review of the current state of research regarding a definition of therapeutic nursing. For this purpose, a systematic study was conducted to examine if there are, nationally or internationally, any definitions of therapeutic nursing and to identify what the therapeutic aspects of nursing are.

METHODS

The research included following database; Medline, Cinahl and Embase. Additionally, a research by hand of several German journals as well as textbooks and specialized literature was carried out.

RESULTS

5 studies were selected which define the term "therapeutic nursing". Among these are one review, one primary study, one theoretical discussion and one dissertation. Further twenty four studies were identified which do not define the term, but are closely related to the subject, and use or characterize the term in various contexts.

CONCLUSIONS

The publications examined provided indications of duties, interventions and roles nurses should perform, but not how to carry these out, nor what is therapeutic about the nursing. At the same time, the low number of studies reveals that therapeutic nursing has barely been examined and demonstrates the lack of theoretically grounding through nursing science.

Before empowerment: residents' memories of the role of the housemother in diaconal residential care settings in Germany 1945-1995

In the 20th century, houseparent families represented a significant resource in the long-term care of people with mental illnesses and physical disabilities in diaconical care settings in Germany. In theory, such families could therefore be understood as a type of institutional family: groups which occasionally use familial patterns of reciprocity but are not themselves families. As little empirical material on life in institutional families existed, a qualitative study was undertaken to explore the experiences of contemporary witnesses, particularly those who had experienced the duties and responsibilities of housemothers in the second half of the 20th century. This paper has combined the experiences of residents (n= 8) and biological children of houseparents (n= 5) from a qualitative study (n= 42). The qualitative study took a grounded theory approach, with the phenomena of power and domination forming the central category. The findings show that life in houseparent families of the time was shaped by rules which the family members had to obey. This study explores a highly controversial area which is of great relevance for current mental health nursing practice: the power relations in diaconal families. This demonstrates the importance of integrating autonomy and empowerment into everyday communal life and contributes to professional nursing practice.

Expression of E-cadherin/catenin complexes in breast cancer

Expression of E-cadherin, alpha-, beta- and gamma-catenins were studied in 100 patients with primary breast cancer compiled of 57 invasive ductal carcinomas (IDC) and 43 invasive lobular carcinomas (ILC) by means of immunohistochemistry. Loss of E-cadherin was observed in 26 (45.6%), and alpha-, beta- and gamma-catenin expression was lacking in 22 (38.6%), 27 (47.4%) and 22 (38.6%) IDCs, respectively. The expression in ILCs was significantly lower, as compared to IDCs (p<0.001). Immunostaining of both E-cadherin and catenins was completely lacking in 27 (47.4%) IDCs and 30 (93.8%) ILCs. Go-expression of E-cadherin/beta-catenin or E-cadherin/gamma-catenin was preserved more frequently than that of E-cadherin/alpha-catenin complexes. E-cadherin/catenin complex expression showed significant positive correlation with histological differentiation (p=0.037), ER (p=0.017) and PR expression (p=0.052), and negative correlation with c-erbB-2 receptor overexpression (p=0.046). Patients with tumours showing adhesion complexes containing alpha-catenin had an increased overall survival rate compared to other patients. Expression of either E-cadherin or alpha-catenin only, without the formation of entire adhesion complexes, was not correlated with overall survival. Thus, determination of both E-cadherin and catenins is suggested to add further information to estimate the prognosis of breast cancer patients.

Current approach to diagnosis and management of acute renal failure in myeloma patients

Renal impairment is a serious complication of multiple myeloma. The primary cause of renal failure in myeloma is damage to the kidney by excessive amounts of light chain produced by the myeloma tumor, giving rise to cast nephropathy (myeloma kidney), although there are several other important precipitants. Significantly poor prognosis is observed in patients who do not recover their renal function; however, with the advent of more effective therapies and a greater understanding of the pathogenesis of the underlying process, it has become possible to reverse renal impairment in greater numbers of patients. Determining whether the renal impairment is due to cast nephropathy should be the first priority, and once the diagnosis is confirmed, appropriate treatment should be initiated without delay. Reduction of serum free light chain is the key to recovery of renal function in these patients. The role of chemotherapy and extracorporeal removal of light chain are discussed.

[Intensified rehabilitation aftercare (IRENA): utilization alongside work and changes in work-related parameters]

BACKGROUND

An aftercare programme following medical rehabilitation may be beneficial in order to reinforce and stabilize the positive effects of rehabilitation and to encourage individual health-related modifications of behaviour and lifestyle. Medical rehabilitation and the aftercare programme of the German Pension Insurance Fund primarily are intended to sustain earning capacity. As part of an evaluation of the Intensified Rehabilitation Aftercare Programme (IRENA) established by the German Pension Insurance Fund, work-related aspects in orthopaedic patients were analyzed based on various data sources. Firstly, the significance of institutional and individual conditions for utilization of IRENA alongside work was of interest. Secondly, the IRENA participants' judgements of the changes of work-related parameters due to the programme were examined, differentiating specifically by extent of earning capacity impairments as well as by particular work problems.

METHODS

The data set used for the analysis is composed of person-related routine data of the German Pension Insurance Fund relative to IRENA records of the year 2007 (n=30 663), interview data from orthopaedic rehabilitation centres providing IRENA (n=225), and questionnaires of IRENA participants (n=750) that were either collected during a broad evaluation of the IRENA programme or provided by the German Pension Insurance Fund.

RESULTS

The results show that the compatibility of IRENA and work is facilitated by the institutional conditions. However, differences between inpatient and outpatient settings have to be recognized. The possibilities to participate in IRENA throughout the day frequently are more diverse in an outpatient setting. In contrast to inpatient centres, outpatient rehabilitation centres see clearly better chances for patients to return to work and to participate in IRENA alongside. With respect to the work-related parameters (work ability, periods of sick leave), clear improvements were reported by participants from the start of rehabilitation to the survey time after the end of IRENA. Particular work problems were reported by 33% of the IRENA participants. The work ability at the end of rehabilitation was found to have been the essential factor for improvement of work ability following IRENA. Particular work problems, however, had no influence, these individuals profited from IRENA to an equal extent.

CONCLUSIONS

Institutional and individual view show that IRENA is compatible with utilization alongside work. Also, IRENA combined with prior medical rehabilitation will bring about subjective improvements in health and work-related parameters.

[Project "FrühStart"--family midwives in Saxony-Anhalt. Their networking with other health care and child welfare professionals and subjective view of the families]

The project "Family midwives in Saxony-Anhalt" was evaluated by a multidimensional approach in order to document the subjective perspective of the mothers as well as the networking of health care and child welfare professionals, while caring for highly vulnerable families. The documentation of 734 cases and quantitative data of 33 family midwives were analyzed. Ten mothers were interviewed and problem-focused expert interviews were carried out with 39 health care and child welfare professionals. The method of coding the interview texts was both open and guided by the research questions. After finishing the qualification course and while caring for highly vulnerable families, the networking of family midwives with child welfare professionals significantly increased. Besides the family midwives and the youth welfare office, the antenatal counseling centers were important "gatekeepers". An important ingredient for constructive networking and care for families is trust which draws on client-oriented care, availability, and advocacy by the family midwives. While the family midwives are respected as partners by the professionals of the child welfare system, networking with obstetricians and hospitals is unsatisfactory. In order to improve this, the latter must be a future goal.

[Adherence and cognitive performance in schizophrenia]

BACKGROUND

It is known that many patients with schizophrenia show non-adherence with regard to antipsychotic medication. Furthermore, many studies indicate cognitive deficits in schizophrenic patients. In this review, we compare the results of studies examining the relationship of non-adherence and cognitive performance.

METHOD

Based on a systematic literature review, the impact of cognitive performance on the adherence behaviour of patients with schizophrenia was examined.

RESULTS

We found 18 studies analysing the impact of cognitive performance on adherence behaviour. Most studies indicated that patients with stronger cognitive impairments show lower adherence behaviour. Possible causal mechanisms are discussed.