[Management of Adult Community-Acquired Pneumonia and Prevention - Update 2021 - Guideline of the German Respiratory Society (DGP), the Paul-Ehrlich-Society for Chemotherapy (PEG), the German Society for Infectious Diseases (DGI), the German Society of Medical Intensive Care and Emergency Medicine (DGIIN), the German Viological Society (DGV), the Competence Network CAPNETZ, the German College of General Practitioneers and Family Physicians (DEGAM), the German Society for Geriatric Medicine (DGG), the German Palliative Society (DGP), the Austrian Society of Pneumology Society (ÖGP), the Austrian Society for Infectious and Tropical Diseases (ÖGIT), the Swiss Respiratory Society (SGP) and the Swiss Society for Infectious Diseases Society (SSI)]. / Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie ­ Update 2021.

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie: update 2021

Die vorliegende Leitlinie umfasst ein aktualisiertes Konzept der Behandlung und Prävention von erwachsenen Patienten mit ambulant erworbener Pneumonie und löst die bisherige Leitlinie aus dem Jahre 2016 ab. Sie wurde entsprechend den Maßgaben zur Methodologie einer S3-Leitlinie erarbeitet und verabschiedet. Hierzu gehören eine systematische Literaturrecherche und -bewertung, die strukturierte Diskussion der aus der Literatur begründbaren Empfehlungen sowie eine Offenlegung und Bewertung möglicher Interessenskonflikte. Die Leitlinie zeichnet sich aus durch eine Zentrierung auf definierte klinische Situationen, eine aktualisierte Maßgabe der Schweregradbestimmung sowie Empfehlungen zu einer individualisierten Auswahl der initialen antimikrobiellen Therapie. Die Empfehlungen zielen gleichzeitig auf eine strukturierte Risikoevaluation als auch auf eine frühzeitige Bestimmung des Therapieziels, um einerseits bei kurativem Therapieziel die Letalität der Erkrankung zu reduzieren, andererseits bei palliativem Therapieziel eine palliative Therapie zu eröffnen.

The present guideline provides a new and updated concept of the management of adult patients with community-acquired pneumonia. It replaces the previous guideline dating from 2016.The guideline was worked out and agreed on following the standards of methodology of a S3-guideline. This includes a systematic literature search and grading, a structured discussion of recommendations supported by the literature as well as the declaration and assessment of potential conflicts of interests.The guideline has a focus on specific clinical circumstances, an update on severity assessment, and includes recommendations for an individualized selection of antimicrobial treatment.The recommendations aim at the same time at a structured assessment of risk for adverse outcome as well as an early determination of treatment goals in order to reduce mortality in patients with curative treatment goal and to provide palliation for patients with treatment restrictions.

Modelos de regressão aleatória para características de crescimento de bovinos da raça Nelore do estado de Mato Grosso / Random regression models to traits of growth in the Nellore breed in Mato Grosso state

Foram utilizados 138.976 registros de informações de pesos corporais variando de 60 a 610 dias de idade, provenientes de 27.327 animais da raça Nelore, oriundos de rebanhos do estado do Mato Grosso, com o objetivo de descrever a variabilidade genética e estimar parâmetros genéticos para o peso corporal em diferentes idades, utilizando-se modelos de regressão aleatória. O modelo empregado incluiu efeitos fixos de grupo de contemporâneos e idade da vaca ao parto como covariáveis, além de efeitos aleatórios genético aditivo direto, genético materno, ambiente permanente de animal, ambiente permanente materno e efeito de ambiente temporário. O modelo de regressão aleatória mais adequado foi o que empregou função de covariância com polinômios de quarta ordem para descrição da variabilidade de todos os efeitos e duas classes de variância residual. As estimativas de variância genética aditiva direta e de ambiente permanente de animal aumentaram com a idade dos animais. As variâncias genética materna e de ambiente permanente materno exibiram comportamento semelhante, com maiores valores na fase de aleitamento. Os coeficientes de herdabilidade estimados variam de 0,25 a 0,43, com maiores valores nas idades mais avançadas na trajetória de crescimento dos animais. Esses resultados indicaram presença de variabilidade genética suficiente para obtenção de ganho genético expressivo por meio da seleção, principalmente após desmama. Os resultados encontrados para a correlação genética aditiva direta exibiram baixas correlações entre pesos nas idades iniciais e finais, porém pesos altamente correlacionados entre idades mais próximas. As correlações genéticas estimadas entre os pesos da desmama com os pesos até 610 dias de idade foram altas e positivas e indicam que os genes responsáveis por maiores pesos nesse período, em sua maioria, são os mesmos.

In this study 138,976 records of live weight between 60 to 610 days of age, from 27,327 Nellore cattle breed, from herds in Mato Grosso State were used in order to describe the genetic variability and to estimate genetic parameters for the live weight at different ages, using random regression models. The model included the fixed effects of contemporary group and age of cow at calving as covariate, random effects of direct additive genetic, maternal genetic, animal and maternal permanent environmental and temporary environment effect. The most appropriate random regression model employed the covariance function with fourth order polynomials to describe the variability of all effects and two residual variance classes. Estimates of direct additive genetic variance and animal permanent environment increased with the age of the animals. Maternal genetic variances and maternal permanent environment exhibited similar behavior, with higher values in pre weaning. The estimated heritability coefficients ranged from 0.25 to 0.43, with higher values at older ages in the growth trajectory of the animals. These results showed the presence of sufficient genetic variability to obtain significant genetic gain through selection, especially after weaning. The results for the direct additive genetic correlation exhibited low correlations between weights in initial and final ages, however, highly correlated weights between nearest ages. Genetic correlation estimates between weaning with weights up to 610 days of age were high and positive and indicate that most of the genes responsible for higher weights in this period are the same.

Physician communication in a lung cancer center--does the message come across?

OBJECTIVE: Lung cancer patients require information about their diagnosis, treatment procedure and the treatment goal. We have examined recall of patients and how satisfied they were with physician communication. PATIENTS AND METHODS: 101 patients with newly diagnosed lung cancer were interviewed shortly after the disclosure of diagnosis about their diagnosis, treatment procedure and treatment goal. Disclosing physicians were asked what information they had given. Physician information and patient recall was then compared. RESULTS: Eighty-six percent (86 of 100 patients) knew their diagnosis, 81% recalled the treatment procedure correctly, and 42% knew if the treatment goal was curative or palliative. We found high satisfaction about communication of diagnosis and treatment procedure (83% resp.77%). However, satisfaction with communication of the treatment goal was 53% (51 of 97 patients) and significantly lower than satisfaction with communication of diagnosis and of treatment procedure. Patients who were informed by male physicians were significantly more satisfied with the disclosure about the treatment goal. CONCLUSIONS: Treatment goals are difficult to convey by untrained physicians. Further research is needed to understand how we can improve patients' understanding of and satisfaction with information about the treatment goal and prognosis and how physicians can improve their communication skills.

[Rational tumour documentation and quality assurance to improve the standard of medical care for lung cancer patients]. / Rationale Tumordokumentation und Qualitätssicherung zur Verbesserung der Versorgungsqualität für Lungenkrebspatienten.

The data on the quality of care of patients with lung cancer in Germany are insufficient. Although the National Lung Cancer Guideline from 2010 provides a good scientific basis for the management of the frequently complex pathways, no evidence exists showing how the relevant guideline recommendations are implemented nationwide or which treatment options generally are chosen in a tumour entity with one of the poorest prognoses. As part of the National Cancer Plan 2008, specific targets have been formulated for the systematic improvement of cancer care in Germany. As a main goal, the national re-organisation and harmonisation of tumor documentation and quality assurance are required for a sustainable improvement in the quality of care. This review article first describes the relevant terms and then examines how the specific targets of the National Cancer Plan have been implemented so far with regard to lung cancer care.

[The need for palliative care treatment in pneumology in non-malignant diseases--a case report]. / Bedarf für eine palliativmedizinische Versorgung in der Pneumologie bei nicht malignen Erkrankungen--ein Fallbericht.

A 70-year-old pneumological patient with a COLD for many years, who was using long-term oxygen therapy, developed a complex clinical presentation. During his inpatient course over several weeks we treated severe physical symptoms such as shortness of breath, anxiety and pain. After the transfer to the palliative care ward only an inpatient final accompaniment was possible. In this case the palliative care expertise was integrated too late into the process of the therapy. The delay led to a poorer control of severe physical symptoms such as those named above. Also, the patients request for comprehensive ambulant care could not be realised because the severity of the disease was not detected soon enough. Instruments for the evaluation of the need for an additional palliative care treatment in patients with a non-malignant pneumological disease have not been established sufficiently.

[Lung cancer in Germany - the current state of management]. / Lungenkrebs in Deutschland - zur Versorgungslage der Nation.

BACKGROUND: The care of lung cancer patients in Germany has not been systematically evaluated yet. The aim of this article is to give an overview on the current state of lung cancer care on the basis of existing data. METHODS: In April and May 2010, a literature search was performed in order to collect relevant information concerning epidemiology as well as diagnostic, therapeutic (systemic therapy, radiotherapy, surgery, palliative therapy), and interdisciplinary structures in lung cancer treatment. RESULTS: The published database on lung cancer care in Germany is overall deficient. Treatment of lung cancer patients is mainly located in hospitals, particularly in chest clinics or specialised departments. The access of hospitals for an outpatient treatment as provided per § 116 b SGB V has not yet been realised in all German states. CONCLUSIONS: A systematic and prospective evaluation of lung cancer care is necessary in order to better allocate resources in the future.

Immunoreactive secretin release following taurocholate perfusions of the cat duodenum.

Perfusion of the cat duodenum with sodium taurocholate (TC), 120 mmol/l, at pH 6.1 increased the plasma immunoreactive (IRS) concentration from 2.2 +/- 0.7 pmol/l to 29 +/- 6.1 pmol/l during the first 20 min. This was accompanied by an increased pancreatic secretion of fluid, while the chymotrypsin output showed a "wash-out' phenomenon. TC increased both the bile-acid-dependent and the bile-acid-independent bile secretion. In comparison, HCl, 150 mmol/l, increased IRS from 0.9 +/- 0.5 pmol/l to 41 +/- 15 pmol/l, producing an increase in the pancreatic fluid secretion. However, only a slight increase in the bile-acid-independent bile secretion was found, and the bile-acid-dependent secretion did not change. The effects of TC on the pancreatic secretion were produced at concentrations occurring in cat hepatic bile.