[SARS-CoV-2 Exposure and Seroprevalence of SARS-CoV-2 Antibodies among Medical Students in the First Phase of the Pandemic 2020-2021]. / SARS-CoV-2 Exposition und Seroprävalenz von SARS-CoV-2-Antikörpern bei Medizinstudierenden in der ersten Phase der Pandemie, 2020­2021.

BACKGROUND: Due to their clinical training and secondary activities in the hospital, medical students are exposed to contact with SARS-CoV-2 infected people more often than the general population. We determined the seroprevalence of SARS-CoV-2 antibodies in medical students in clinical training at different times during the pandemic and asked participants about possible SARS-CoV-2 exposures in both medical and private settings. METHODS: From May 2020 to June 2021, medical students each in their 3rd year of training at the University Hospital Würzburg participated in the cross-sectional survey. All SARS-CoV-2 unvaccinated students were offered a determination of their SARS-CoV-2 serostatus. The blood samples were tested by an immunoassay (Elecsys, Roche) for IgG/IgM/IgA antibodies against the SARS-CoV-2 N antigen. Demographic data, SARS-CoV-2 disease and vaccination status, as well as possible SARS-CoV-2 exposures were collected using a questionnaire. RESULTS: Overall, 383 (86.1%) of 445 students took part in the cross-sectional survey (65% female; median age 22 years; IQR 21-24). Serostatus was determined in 223 (58.2% of 383) SARS-CoV-2 unvaccinated participants. In the period between the beginning of the pandemic in Germany (February 2020) and the time of the survey, 332 (86.7% of 383) students stated that they worked in the medical field, mainly in the context of clinical traineeships (76.8%) or secondary activities with patient contact (48.8%); 129 (33.7%) reported previous contact with a COVID-19 patient, of which 78.3% of contacts took place at a medical facility. Antibodies against SARS-CoV-2 were detected in 8 (3.6%) of the 223 unvaccinated participants tested, and in 3 infected persons an association between infection and contact in the course of medical activity seemed likely. CONCLUSION: Despite frequent patient contact and the associated increased risk of infection, medical students in their 3rd year of training did not show an increased seroprevalence compared to the general population and showed a lower or similar seroprevalence rate than medical students in other European countries in the first 18 months of the pandemic. This indicates sufficient protection of medical students at the beginning of clinical training through the hygiene and infection protection measures implemented at that time during medical activities.

Comparative morphology of serotonin-immunoreactive neurons innervating the central complex in the brain of dicondylian insects.

Serotonin (5-hydroxytryptamine) acts as a widespread neuromodulator in the nervous system of vertebrates and invertebrates. In insects, it promotes feeding, enhances olfactory sensitivity, modulates aggressive behavior, and, in the central complex of Drosophila, serves a role in sleep homeostasis. In addition to a role in sleep-wake regulation, the central complex has a prominent role in spatial orientation, goal-directed locomotion, and navigation vector memory. To further understand the role of serotonergic signaling in this brain area, we analyzed the distribution and identity of serotonin-immunoreactive neurons across a wide range of insect species. While one bilateral pair of tangential neurons innervating the central body was present in all species studied, a second type was labeled in all neopterans but not in dragonflies and firebrats. Both cell types show conserved major fiber trajectories but taxon-specific differences in dendritic targets outside the central body and axonal terminals in the central body, noduli, and lateral accessory lobes. In addition, numerous tangential neurons of the protocerebral bridge were labeled in all studied polyneopteran species except for Phasmatodea, but not in Holometabola. Lepidoptera and Diptera showed additional labeling of two bilateral pairs of neurons of a third type. The presence of serotonin in systems of columnar neurons apparently evolved independently in dragonflies and desert locusts. The data suggest distinct evolutionary changes in the composition of serotonin-immunolabeled neurons of the central complex and provides a promising basis for a phylogenetic study in a wider range of arthropod species.

[Implementation of Advance Care Planning in a Regional Network]. / Umsetzung von Advance Care Planning in einem regionalen Netzwerk.

Implementation of Advance Care Planning in a Regional Network Abstract. Since 2017, the ACP concept, known in Germany as Health Care Planning for the Final Phase of Life (GVP) has offered residents of inpatient facilities for elderly care and integration assistance a special consultation service by trained consultants on medical and nursing care options and their care in the final phase of life. In order for the counselling and documentation of wishes and preferences to be followed by good implementation of the individual GVP, a reliable flow of information and coordinated action processes between the players involved in the facilities as well as the external service providers, such as physicians and prehospital emergency medical service staff, are essential. Cross-sectoral coordination processes and regional networking of the players involved can contribute to the development of concrete procedures and uniform processes for implementing GVP in a region. In order to identify the necessary steps for the implementation of GVP and to be able to describe quality criteria for the implementation of GVP in regional networks, four regions in North Rhine-Westphalia were selected and supported as models within the framework of a state project. Initial experiences in the state project point to some overarching factors that contribute significantly to good implementation of GMPs in regional networks.

Tyrosine hydroxylase immunostaining in the central complex of dicondylian insects.

Dopamine acts as a neurohormone and neurotransmitter in the insect nervous system and controls a variety of physiological processes. Dopaminergic neurons also innervate the central complex (CX), a multisensory center of the insect brain involved in sky compass navigation, goal-directed locomotion and sleep control. To infer a possible influence of evolutionary history and lifestyle on the neurochemical architecture of the CX, we have studied the distribution of neurons immunoreactive to tyrosine hydroxylase (TH), the rate-limiting enzyme in dopamine biosynthesis. Analysis of representatives from 12 insect orders ranging from firebrats to flies revealed high conservation of immunolabeled neurons. One type of TH-immunoreactive neuron was found in all species studied. The neurons have somata in the pars intercerebralis, arborizations in the lateral accessory lobes, and axonal ramifications in the central body and noduli. In all pterygote species, a second type of tangential neuron of the upper division of the central body was TH-immunoreactive. The neurons have cell bodies near the calyces and arborizations in the superior protocerebrum. Both types of neuron showed species-specific variations in cell number and in the innervated areas outside and inside the CX. Additional neurons were found in only two taxa: one type of columnar neuron showed TH immunostaining in the water strider Gerris lacustris, but not in other Heteroptera, and a tritocerebral neuron innervating the protocerebral bridge was immunolabeled in Diptera. The data show largely taxon-specific variations of a common ground pattern of putatively dopaminergic neurons that may be commonly involved in state-dependent modulation of CX function.

Orcokinin in the central complex of the locust Schistocerca gregaria: Identification of immunostained neurons and colocalization with other neuroactive substances.

The central complex is a group of highly interconnected neuropils in the insect brain. It is involved in the control of spatial orientation, based on external compass cues and various internal needs. The functional and neurochemical organization of the central complex has been studied in detail in the desert locust Schistocerca gregaria. In addition to classical neurotransmitters, immunocytochemistry has provided evidence for a major contribution of neuropeptides to neural signaling within the central complex. To complement these data, we have identified all orcokinin-immunoreactive neurons in the locust central complex and associated brain areas. About 50 bilateral pairs of neurons innervating all substructures of the central complex exhibit orcokinin immunoreactivity. Among these were about 20 columnar neurons, 33 bilateral pairs of tangential neurons of the central body, and seven pairs of tangential neurons of the protocerebral bridge. In silico transcript analysis suggests the presence of eight different orcokinin-A type peptides in the desert locust. Double label experiments showed that all orcokinin-immunostained tangential neurons of the lateral accessory lobe cluster were also immunoreactive for GABA and the GABA-synthesizing enzyme glutamic acid decarboxylase. Two types of tangential neurons of the upper division of the central body were, furthermore, also labeled with an antiserum against Dip-allatostatin I. No colocalization was found with serotonin immunostaining. The data provide additional insights into the neurochemical organization of the locust central complex and suggest that orcokinin-peptides of the orcokinin-A gene act as neuroactive substances at all stages of signal processing in this brain area.

Online-rotation in paediatrics - digital live-interaction with children.

The two-week block rotation in paediatrics (tenth semester) took place for 62 students purely as online teaching in the summer semester of 2020, at the time of the initial restrictions. As a teaching module, virtual patient presentations including debriefing took place as synchronous teaching. Patients and one parent were broadcast from the wards and outpatient clinics via video conference. Students were able to interact in small groups with 15-22 patients or their parents, respectively, via a doctor and both conduct the case history interview and brief the examination steps. Despite the limitation of not being able to perform the clinical examination themselves, participants rated the block rotation with good marks. They particularly appreciated the ability to interact with the children online as an indispensable compromise in times of suspended classroom teaching during the SARS-CoV-2 pandemic.

[Recommendations for the support of suffering, severely ill, dying or grieving persons in the corona pandemic from a palliative care perspective : Recommendations of the German Society for Palliative Medicine (DGP), the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI), the Federal Association for Grief Counseling (BVT), the Working Group for Psycho-oncology in the German Cancer Society, the German Association for Social Work in the Healthcare System (DVSG) and the German Association for Systemic Therapy, Counseling and Family Therapy (DGSF)]. / Empfehlungen zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona-Pandemie aus palliativmedizinischer Perspektive : Empfehlungen der Deutschen Gesellschaft für Palliativmedizin (DGP), der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI), des Bundesverbands Trauerbegleitung (BVT), der Arbeitsgemeinschaft für Psychoonkologie in der Deutschen Krebsgesellschaft, der Deutschen Vereinigung für Soziale Arbeit im Gesundheitswesen (DVSG) und der Deutschen Gesellschaft für Systemische Therapie, Beratung und Familientherapie (DGSF).

The corona pandemic has led to a number of restrictions and prohibitions, which in turn place large psychosocial or spiritual burdens on patients with COVID-19, their families and relatives and the treating personnel in the healthcare system. Patients with COVID-19 are not allowed to receive visitors and many hospitals and nursing homes have completely banned visitors. Many support services have been reduced or stopped completely. Necessary treatment interventions for other patients with critical and life-limiting diseases have been delayed or suspended in order to free resources for the expected COVID-19 patients; however, these people need to feel social connectedness with their relatives. Palliative care patients should be exempted from any ban on visitors. Families should be able to visit dying patients even on intensive care units or isolation wards, using adequate protective equipment. Alternative options, such as video telephone calls or via social media should be explored for patients in isolation. Families should also be enabled to say goodbye to the deceased with adequate protective equipment or should be offered alternative real or virtual options for remembrance and commemoration. Health care professionals coping with the exceptional stress should be continuously supported. This requires clear communication and leadership structures, communication training, psychosocial support, but most of all optimal framework conditions for the clinical work.

Characterization of Inflammasome Components in Pig Intestine and Analysis of the Influence of Probiotic Enterococcus Faecium during an Escherichia Coli Challenge.

The aim of the present study was to investigate systematically the expression of inflammasome components in pig intestine and to analyze the influence of age and long-term supplementation with the probiotic Enterococcus faecium NCIMB 10415 (E. faecium). In order to examine probiotic effects on the inflammasomes during a challenge with pathogens, enterotoxigenic Escherichia coli (ETEC) and E. faecium were directly added to pig jejunum in Ussing chambers. The mRNA expression of inflammasome components generally decreased in an oral-aboral direction in intestinal tissues. In 29-day-old piglets, the expression levels of NLRP3 were significantly higher and ASC (apoptotic speck-like protein containing a caspase recruitment domain) expression were lower compared with those in the ileum of 70-day-old pigs (p ≤ 0.05). Long-term supplementation with E. faecium significantly increased ASC expression levels in the jejunum and ileum of 29-day-old piglets compared to control animals (p ≤ 0.05). Ex vivo addition of ETEC or E. faecium did not affect mRNA expression of inflammasome components significantly, whereas IL-1ß protein release was significantly elevated in ETEC-incubated jejunum (p ≤ 0.05), providing evidence for the functional activation of the inflammasome, which was prevented by pre-incubation with E. faecium. We conclude that pre-incubation with E. faecium has a protective effect during ETEC challenge; this effect is probably not located at the inflammasome transcription level. The results of this study of the expression and regulation of inflammasome components in pigs are similar to those obtained in humans, reinforcing the use of pigs as a suitable model for translational inflammasome research.

Mindfulness and compassion-oriented practices at work reduce distress and enhance self-care of palliative care teams: a mixed-method evaluation of an "on the job" program.

BACKGROUND: Maintaining a sense of self-care while providing patient centered care, can be difficult for practitioners in palliative medicine. We aimed to pilot an "on the job" mindfulness and compassion-oriented meditation training for interdisciplinary teams designed to reduce distress, foster resilience and strengthen a prosocial motivation in the clinical encounter. METHODS: Our objective was to explore the feasibility and effectiveness of this newly developed training. The study design was an observational, mixed-method pilot evaluation, with qualitative data, self-report data, as well as objective data (cortisol) measured before and after the program. Twenty-eight staff members of an interdisciplinary palliative care team participated in the 10-week training conducted at their workplace. Measures were the Perceived Stress Questionnaire, the Maslach Burnout Inventory, the somatic complaints subscale of the SCL-90-R, the Emotion Regulation Skills Questionnaire, the Hospital Anxiety and Depression Scale, and a Goal Attainment Scale that assessed two individual goals. Semi-structured interviews were employed to gain insight into the perceived outcomes and potential mechanisms of action of the training. T-tests for dependent samples were employed to test for differences between baseline and post-intervention. RESULTS: Significant improvements were found in two of three burnout components (emotional exhaustion and personal accomplishment), anxiety, stress, two emotional regulation competences and joy at work. Furthermore, 85% of the individual goals were attained. Compliance and acceptance rates were high and qualitative data revealed a perceived enhancement of self-care, the integration of mindful pauses in work routines, a reduction in rumination and distress generated in the patient contact as well as an enhancement of interpersonal connection skills. An improvement of team communication could also be identified. CONCLUSIONS: Our findings suggest that the training may be a feasible, effective and practical way of reducing caregiver-distress and enhancing the resources of palliative care teams.

Altered Cytokine Expression and Barrier Properties after In Vitro Infection of Porcine Epithelial Cells with Enterotoxigenic Escherichia coli and Probiotic Enterococcus faecium.

The aim of the present study was to elucidate the effects of the probiotic feed additive Enterococcus faecium NCIMB 10415 (E. faecium) on porcine jejunal epithelial cells (IPEC-J2) during an in vitro challenge with enterotoxigenic Escherichia coli (ETEC). Cells were incubated with E. faecium, ETEC, or both, and the effects on barrier function and structure and intra- and intercellular signaling were determined. Coincubation with E. faecium abolished the ETEC-induced decrease in transepithelial resistance (Rt) (p ≤ 0.05). No differences were seen in the expression levels of the intercellular connecting tight junction proteins examined. However, for the first time, a reorganization of the monolayer was observed in ETEC-infected cells but not in coincubated cells. ETEC induced an increase in cytotoxicity that was prevented by coincubation (p ≤ 0.05), whereas apoptosis rates were not affected by bacterial treatment. ETEC increased the mRNA expression and release of proinflammatory cytokines TNF-α, IL-1α, and IL-6 which could be prevented by coincubation for TNF-α mRNA expression and IL-6 protein (p ≤ 0.05). Likewise, cAMP concentrations elevated by ETEC were reduced in coincubated cells (p ≤ 0.05). These findings indicate a protective effect of the probiotic E. faecium on inflammatory responses during infection with ETEC.

Effects of Ex Vivo Infection with ETEC on Jejunal Barrier Properties and Cytokine Expression in Probiotic-Supplemented Pigs.

BACKGROUND AND AIM: Enterotoxigenic Escherichia coli (ETEC) strains are involved in piglet post-weaning diarrhea. Prophylactic measures including probiotics have been examined in infection experiments with live piglets. In the present study, we have tested whether the early effects of ETEC infection can also be evoked and studied in a model in which ETEC is added to whole mucosal tissues ex vivo, and whether this response can be modulated by prior supplementation of the piglets with probiotics. METHODS: Jejunal barrier and transport properties of Enterococcus faecium-supplemented or control piglets were assessed in Ussing chambers. Part of the epithelia was challenged with an ETEC strain at the mucosal side. Fluxes of fluorescein as a marker of paracellular permeability, and the expression of selected tight junction (TJ) proteins and of proinflammatory cytokines were measured. RESULTS: The addition of ETEC ex vivo induced an increase in transepithelial resistance peaking in the first 2 h with a concomitant reduction in fluorescein fluxes, indicating tightening effects on barrier function. The response of short-circuit current after stimulation with PGE2 or glucose was reduced in epithelia treated with ETEC. ETEC induced a decrease in the TJ protein claudin-4 in the control diet group after 280 min and an increase in the mRNA expression of the proinflammatory cytokines interleukin-8 and TNF-α in both groups after 180 min. CONCLUSIONS: The addition of ETEC ex vivo affected barrier function and transport properties of the jejunal tissues and enhanced cytokine expression. The differences in claudin-4 expression in the jejunum might indicate a beneficial effect of E. faecium prefeeding.

German nursing home professionals' knowledge and specific self-efficacy related to palliative care.

BACKGROUND: In Germany, more and more terminally ill patients spend their last days of life in nursing homes, and this presents a challenge for these institutions. Even though palliative care is a growing domain in health care, no quantitative in-depth evaluations of the status quo in nursing homes has been conducted so far in Germany, partly because of lacking measuring tools. OBJECTIVE: This study used a new questionnaire to assess German health care professionals' theoretical knowledge of palliative care and their perceived self-efficacy. Both variables have been proven to be indicators for the quality of the implementation of palliative care in nursing homes. METHODS: We used the Bonn Palliative Care Knowledge Test (Bonner Palliativwissenstest, BPW) questionnaire to measure knowledge of palliative care in the domains of medicine, care, and psychosocial care and to measure self-efficacy relating to palliative care. RESULTS: Care workers (N=130) in five nursing homes in the region of Aachen in western Germany answered the questionnaires. The results show low knowledge (on average 52.8% correct answers) and self-efficacy relating to palliative care, although work with dying people is their daily challenge. While general knowledge correlated with work experience, a negative correlation of specific self-efficacy with age and working experience was observed. CONCLUSIONS: Lower self-efficacy of care workers experienced in palliative care probably implies that the difficulty of palliative care skills is underestimated by inexperienced care workers. Palliative care training is urgently needed to improve knowledge and self-efficacy. Guidance to assist care professionals involved in palliative care in nursing homes needs to be developed and provided.

Fungating Wounds - Multidimensional Challenge in Palliative Care.

SUMMARY: The management of fungating, malignant wounds is a challenge for the palliative care team. Open, malodorous, poorly healing lesions are obvious signs of underlying disease. In addition, pain and functional impairment remind the patients of their incurable illness. A multidimensional approach is necessary to meet the needs of these patients and to improve quality of life. Although achieving wound closure is rarely a realistic goal, modern techniques of wound management can help to minimize odours and exudates. Specialist knowledge in palliative care is needed to provide adequate pain control. Psychosocial support may help patients to cope with the situation and their limited abilities.

Barriers and needs in paediatric palliative home care in Germany: a qualitative interview study with professional experts.

BACKGROUND: In North-Rhine Westphalia (Germany) a pilot project for an extensive service provision of palliative care for children and adolescents has been implemented. Accompanying research was undertaken with the aim to assess the status quo of service delivery at the outset of the project and to evaluate the effects of the pilot project. As part of the research, barriers and needs with respect to paediatric palliative home care in the target region were explored. METHODS: Semi-structured interviews with 24 experts in the field of paediatrics, palliative and hospice care have been conducted and were analysed by qualitative content analysis. RESULTS: Four main categories emerged from the interviews: (1) specific challenges and demands in palliative care for children and adolescents, (2) lack of clear legal and financial regulations, (3) gaps in the existing care delivery, and (4) access to services. Generally the interviews reflected the observation that the whole field is currently expanding and that certain deficits are temporary barriers that will be resolvable in the medium-term perspective. CONCLUSIONS: Predominant barriers were seen in the lack of clear legal and financial regulations which take into account the specific challenges of palliative care in children and adolescents, as well as in a shortcoming of specialist services for a local based care provision throughout the federal country.