Evaluation of the Quality of Online Information for Patients with Rare Cancers: Thyroid Cancer

The Internet offers an easy and quick access to a vast amount of patient information. However, several studies point to the poor quality of many websites and the resulting hazards of false information. The aim of this study was to assess quality of information on thyroid cancer. A patients' search for information about thyroid cancer on German websites was simulated using the search engine Google and the patient portal "Patienten-Information.de". The websites were assessed using a standardized instrument with formal and content aspects from the German Cancer Society. Supporting the results of prior studies that analysed patient information on the Internet, the data showed that the quality of patient information on thyroid cancer is highly heterogeneous depending on the website providers. The majority of website providers are represented by media and health providers other than health insurances, practices and professionals offering patient information of relatively poor quality. Moreover, most websites offer patient information of low-quality content. Only a few trustworthy, high-quality websites exist. Especially Google, a common search engine, focuses more on the dissemination of information than on quality aspects. In order to improve the patient information from the Internet, the visibility of high-quality websites must be improved. For that, education programs to improve patients' eHealth literacy are needed. A quick and easy evaluation tool for online information suited for patients should be implemented, and patients should be taught to integrate such a tool into their research process.

Accurate determination of rivaroxaban levels requires different calibrator sets but not addition of antithrombin

Rivaroxaban is a direct factor Xa inhibitor, which can be monitored by anti-factor Xa chromogenic assays. This ex vivo study evaluated different assays for accurate determination of rivaroxaban levels. Eighty plasma samples from patients receiving rivaroxaban (Xarelto®) 10 mg once daily and 20 plasma samples from healthy volunteers were investigated using one anti-factor Xa assay with the addition of exogenous antithrombin and two assays without the addition of antithrombin. Two different lyophilised rivaroxaban calibration sets were used for each assay (low concentration set: 0, 14.5, 59.6 and 97.1 ng/ml; high concentration set: 0, 48.3, 101.3, 194.2 and 433.3 ng/ml). Using a blinded study design, the rivaroxaban concentrations determined by the assays were compared with concentrations measured by HPLC-MS/MS. All assays showed a linear relationship between the rivaroxaban concentrations measured by HPLC-MS/MS and the optical density of the anti-FXa assays. However, the assay with the addition of exogenous anti-thrombin detected falsely high concentrations of rivaroxaban even in plasma samples from controls who had not taken rivaroxaban (intercept values using the high calibrator set and the low calibrator set: +26.49 ng/ml and +13.71 ng/ml, respectively). Plasma samples, initially determined by the high calibrator setting and containing rivaroxaban concentrations <25 ng/ml, had to be re-run using the low calibrator setting for precise measurement. In conclusion, anti-factor Xa chromogenic assays that use rivaroxaban calibrators at different concentration levels can be used to measure accurately a wide range of rivaroxaban concentrations ex vivo. Assays including exogenous antithrombin are unsuitable for measurement of rivaroxaban.

Aroma oil therapy in palliative care: a pilot study with physiological parameters in conscious as well as unconscious patients

OBJECTIVE

The aim of this pilot study is to analyze the reactions of healthy test persons and conscious as well as unconscious palliative patients to aroma stimuli.

PATIENTS AND METHODS

In a randomized controlled study, healthy probands, conscious and unconscious palliative patients were exposed to two essential oils (lemon, lavender). Water was used as the control stimulus. Physiological parameters (breathing rate and heart rate, oxygen saturation, systolic, diastolic and mean arterial pressure) were measured.

RESULTS

10 test persons (control group), 15 conscious patients and 5 unconscious palliative patients were exposed to the stimuli. Healthy test persons reacted to lemon oil with a significant increase in respiration rate, heart rate and diastolic blood pressure, whereas to lavender oil with a significant decrease in respiration rate was measured. There were no significant reactions concerning the other parameters. Conscious and unconscious patients reacted with a significant increase in all measured parameters to lemon oil and with a significant decrease in all parameters except for oxygen saturation to lavender oil. No significant differences in the reactions were measured between the conscious and unconscious patients and no significant reactions to control stimuli were detected. All physiological reactions were very short and only detectable during stimulus presentation.

CONCLUSION

Significant physiological reactions were measured after simulation with aroma oils in all three groups in this study. Healthy probands showed different reactions than palliative patients irrespective to their conscious state.