[Implementation of recommendations for the diagnosis of heart failure. [corrected]]. / Umsetzung von diagnostischen Empfehlungen bei Herzinsuffizienz.

BACKGROUND: National and international guidelines for the management of congestive heart failure (HF) suggest a variety of procedures for establishing its diagnosis and monitoring its course. The aim of this cross-sectional study was to investigate which of these recommendations were actually implemented and documented in the setting of general medical practice. METHODS: Patients receiving at least one cardiovascular drug (World health [WHO] anatomical chemical classification [ATC] class C) were identified from electronic medical records from 5 general practices from 1.4.2001 to 1.10.2004. Those patients with the documented diagnosis of HF were selected. All patients' records were reviewed and those diagnostic procedures and clinical findings were recorded on a standardized data extraction form that had been used to establish the diagnosis of HF. RESULTS: An electrocardiogram had been documented or retrieved in the chart in 41.2% of a total of 829 patients, an chest X-ray in 28.2%, an echocardiogram in 17.2%, and a cardiac catheterization performed in 1.8%. Serum natriuretic peptides were never recorded. Additionally the following symptoms and clinical signs were extracted from the paper chart: ankle edema (39.3%), exertional dyspnea (22.7%), rales (21.5%), cardiomegaly (19.0%), paroxysmal dyspnea (16.6%), pleural effusions (9.2%), tachycardia (6.7%) and acute pulmonary edema, hepatomegaly, nocturnal cough or jugular venous distension in fewer than 5%. CONCLUSION: Only a few of those clinical signs and diagnostic procedures recommended by guidelines for diagnosing HF were recorded in general practice. The reasons for this finding remain unclear. Even under the assumption that not all observed clinical signs and diagnostic procedures were documented, these findings reflect the actual diagnostic strategy in daily practice. The observed discrepancy between guideline recommendation and reality in everyday practice deserve attention. On the one hand, there is a need for improving the diagnostic approach to HF; on the other, guidelines need to set priorities of the recommendations for diagnosing HF.

[Problems and deficits in the transition from inpatient and outpatient care of cancer patients. A qualitative analysis]. / Schnittstellenproblematik beim Ubergang von stationärer zu ambulanter Versorgung von Tumorpatienten. Eine qualitative Analyse.

INTRODUCTION: Problems and deficits in the transition between hospital-based and outpatient care of cancer patients were evaluated. The project was initiated by the Public Health Department of the City of Aachen and was carried out with cooperation from all hospitals in the urban areas. METHOD: From September 2002 to April 2003 a total of 145 cancer patients fulfilling the inclusion criteria from 4 regional hospitals were documented at 4 time points within a period of 6-8 weeks by questionnaires, telephone and personal interviews. Aspects of interest were disease type, symptom burden, well-being, the homecare situation and medical aids required. RESULTS: Patients and their relatives reported on inadequate pain management, insufficient preparation of transition, problems in information flow, organisational problems, lack of attention and humaneness, deficiency of care, delay of diagnosis, inadequate access to services, insufficient prescription of drugs and adjuvants, financial problems and quarrels with the health insurance company on payment of aid devices. Coping strategies were mostly non-functional and not problem-orientated. DISCUSSION: Special attention should be paid to psychosocial and interpersonal needs of patients. Volunteers may have an important role in the care of patients and relatives. The introduction of case managers might lead to an advancement of care. Sensitisation of physicians, nurses and other caregivers for deficits in transition of patients is needed and should be covered in palliative care education and training.

[Renal cell carcinoma. Comparative analysis of the prognostic significance of the WHO-classification and the Störkel's prognostic score]. / Das Nierenzellkarzinom. Vergleichende Analyse der prognostischen Bedeutung der WHO-Klassifikation und des Prognosescores nach Störkel.

Due to the increasing epidemiological importance of renal cell carcinoma (RCC) in the past, several studies have been undertaken to evaluate a variety of parameters in view of their aptitude for reliably predicting individual prognosis. Currently, staging according to the TNM classification and pathohistological nuclear grading of the tumor is most widely used for determining prognosis. In the latest edition of the TNM system, a subdivision of the stage pT1 into the stages pT1a and pT1b has been established. Analyzing a total of 129 patients with a postoperative follow-up period of 60 months after radical nephrectomy, we investigated the TNM classification in regard to its prognostic potential with emphasis on the new subdivision of the stage pT1. Furthermore, the results were compared to Störkel's prognostic score, which was first described in 1990 as a useful tool for predicting individual prognosis in patients with RCC. In conclusion, our study demonstrates that subdivision of the stage pT1 into the stages pT1a and pT1b did not result in any improvement concerning the aptitude of the TNM classification to predict individual prognosis. In comparison, Störkel's prognostic score has statistically proven to be superior to the TNM classification in regard to its prognostic potential. According to our experience, determination of Störkel's prognostic score can be easily performed by the pathologist without much expense in the course of daily routine diagnostic procedures. Therefore, we strongly recommend Störkel's prognostic score as the parameter of choice to reliably predict individual prognosis of patients suffering from RCC.

Recombinant truncated dystrophin minigenes: construction, expression, and adenoviral delivery.

Duchenne muscular dystrophy (DMD) is a lethal genetic disorder for which there is currently no effective treatment. Although clinical application of adenoviral vector-mediated gene transfer has not been fully developed, it shows promise for the treatment of DMD. One significant problem posed by adenoviral vector-mediated gene transfer for DMD is that currently available adenoviral vectors cannot accommodate the entire 14-kb dystrophin cDNA. To address this problem, we selectively deleted regions of the murine dystrophin cDNA to produce truncated constructs. We created three constructs, each with an in-frame deletion of a segment (3.0, 4.4, and 5.7 kb) of the spectrin-like repeat region of dystrophin. As an additional modification, we removed the majority of the 3' untranslated region of the cDNA in expression vectors encoding some of these truncated constructs. Comparative quantitative expression studies after transfection into COS and C2C12 mouse muscle cells demonstrate variations in the level of expression with different deletions in the spectrin-like repeat region. Furthermore, deletion of the 3' untranslated region was tested for one recombinant construct and resulted in a reduction in the level of expression in both cell culture systems. Toward the ultimate goal of gene transfer therapy for DMD, we created an adenoviral vector from one of our truncated constructs. Using this vector, we demonstrated truncated dystrophin expression in vitro in primary mdx (dystrophin-deficient) muscle cells and in vivo in mdx mouse muscle. In vivo, recombinant dystrophin was properly localized to the muscle membrane.

Stephen Jay Gould on intelligence.

In The Mismeasure of Man (1981) Stephen Jay Gould provides a typically readable history of one of our most vexatious intellectual enterprises: the scientific study of intelligence. Gould is successful, as always, in rendering the relevant scientific debates accessible to general readers. What Gould does less well is to carry through his attack on prior attempts to understand natural intelligence scientifically: attempting to muster all possible arguments against such science, he conjures up a variety of impossible arguments as well. One such argument urges that Gould's predecessors are not to be taken seriously because they are racists and have let their racism influence their scientific practice. Gould has no difficulty in demonstrating the influence of racism; where he goes astray is in his dismissal of such prior work as simply unscientific because the racist conclusions preceded the collection of data. Advancing hypotheses prior to experimentation is how all of science proceeds, and is no mark of inferior work. And no science is immune to influences--racist or otherwise--from the culture in which it is embedded, as Gould elsewhere readily acknowledges. Another failed argument claims that all of the factor analysts studying intelligence have committed the intellectual sin of reifying the factors uncovered in IQ tests--concluding that the factors are real solely on the basis of how a factor analysis summarizes IQ data. Gould concludes that factor analysis is worthless for the study of intelligence. However: (1) contrary to what Gould suggests, the factor analysts themselves warned against concluding that the factors "discovered" are physiologically real merely on the basis of a factor analysis; and (2) factor analysis nevertheless remains a strong candidate technique for developing causal models worth investigating subsequently by other means.