The OUTREACH study: oncologists of German university hospitals in rotation on a palliative care unit-evaluation of attitude and competence in palliative care and hospice.

PURPOSE: The effect of the duration of an educational rotation presented at a palliative care unit on the palliative care knowledge gain and the increase of palliative care self-efficacy expectations are unclear. METHODS: This national prospective multicenter pre-post survey conducted at twelve German University Comprehensive Cancer Centers prospectively enrolled physicians who were assigned to training rotations in specialized palliative care units for three, six, or twelve months. Palliative care knowledge [in %] and palliative care self-efficacy expectations [max. 57 points] were evaluated before and after the rotation with a validated questionnaire. RESULTS: From March 2018 to October 2020, questionnaires of 43 physicians were analyzed. Physicians participated in a 3- (n = 3), 6- (n = 21), or 12-month (n = 19) palliative care rotation after a median of 8 (0-19) professional years. The training background of rotating physicians covered a diverse spectrum of specialties; most frequently represented were medical oncology (n = 15), and anesthesiology (n = 11). After the rotation, median palliative care knowledge increased from 81.1% to 86.5% (p < .001), and median palliative care self-efficacy expectations scores increased from 38 to 50 points (p < .001). The effect of the 12-month rotation was not significantly greater than that of the 6-month rotation. CONCLUSION: An educational rotation presented in a specialized palliative care unit for at least six months significantly improves palliative care knowledge and palliative care self-efficacy expectations of physicians from various medical backgrounds.

Effect of beta-carotene supplementation and lactation on carotenoid metabolism and mitogenic T lymphocyte proliferation.

BACKGROUND: Information is lacking regarding the effects of beta-carotene supplementation, early lactation, or both on circulating carotenoid concentrations and T lymphocyte proliferation. OBJECTIVES: This study investigated the effects of short-term beta-carotene supplementation (30 mg/d for 28 d) during early lactation (days 4-32 postpartum) on circulating carotenoid concentrations and on the T lymphocyte proliferative response to phytohemagglutinin. DESIGN: Subjects aged 19-39 y were paired [lactating (4 d postpartum) and nonlactating (never pregnant, healthy women)] and randomly assigned to receive either beta-carotene or a placebo. During the study, subjects provided eight 24-h food records for analysis with the NUTRITIONIST IV and US Department of Agriculture carotenoid databases. Nonfasting blood samples were collected at baseline and at 28 d. Plasma analysis included quantification of alpha-carotene, beta-carotene, lutein, lycopene, retinol, and alpha-tocopherol, complete differential blood cell counts, and lymphocyte proliferative activity. RESULTS: beta-Carotene supplementation increased beta-carotene (P < 0.001) and alpha-carotene (P < 0.05) concentrations but did not affect lycopene concentrations significantly. Supplemented women showed significant decreases in plasma lutein (P < 0.03), as did lactating subjects (P < 0.02). Neither lactation nor beta-carotene supplementation affected the T lymphocyte proliferative response to phytohemagglutinin. CONCLUSIONS: Our results suggest that beta-carotene supplementation as well as some events related to parturition, initiation of lactation, or both alter circulating concentrations of lutein. beta-Carotene supplementation does not enhance T lymphocyte immune competence in healthy women.

Chronic ingestion of lycopene-rich tomato juice or lycopene supplements significantly increases plasma concentrations of lycopene and related tomato carotenoids in humans.

The bioavailability of lycopene from tomato juice and 2 dietary supplements, each containing 70-75 mg lycopene, was studied in 15 healthy volunteers in a randomized, crossover design. Subjects ingested lycopene-rich tomato juice, tomato oleoresin, lycopene beadlets, and a placebo for 4 wk each while consuming self-selected diets. Treatment periods were separated by 6-wk washout periods. Plasma lycopene concentrations, assessed at baseline and weekly throughout the treatment periods, were significantly higher during tomato juice, oleoresin, and lycopene beadlet ingestion than during placebo ingestion. Mean (+/-SEM) increases in plasma lycopene at week 4 of tomato juice, oleoresin, and lycopene beadlet ingestion were not significantly different: 0.24 +/- 0.07, 0.23 +/- 0.05, and 0.24 +/- 0.06 micromol/L, respectively. Plasma concentrations of phytofluene and phytoene, which were present in small amounts in tomato juice, oleoresin, and lycopene beadlets, increased significantly with ingestion of these 3 products. Beta-carotene, zeta-carotene, and 2,6-cyclolycopene-1,5-diol (a metabolite of lycopene)--also present in tomato juice and supplements--were significantly increased with consumption of the tomato juice and lycopene beadlets, but not with oleoresin consumption. A marked increase in plasma concentrations of an unknown compound was observed; it was detected in trace amounts in tomato juice, oleoresin, and lycopene beadlets, and had a maximum absorbance at 448 nm and a molecular weight of 556. Concentrations of plasma lycopene and other carotenoids with potential for enhancing human health can be increased by ingestion of realistic amounts of tomato juice. Lycopene appears to be equally bioavailable from tomato juice and the supplements used in this study.

Modulated mitogenic proliferative responsiveness of lymphocytes in whole-blood cultures after a low-carotene diet and mixed-carotenoid supplementation in women.

To determine the effects of dietary carotenes on the mitogenic proliferative responsiveness of blood lymphocytes in vitro, nine premenopausal women were fed a low-carotene diet for 120 d. Low-dose beta-carotene (0.5 mg/d) was given to five subjects on days 1-60, while four received a placebo. All subjects received a low-dose beta-carotene (0.5 mg/d) supplement on days 61-120, plus a carotenoid complex on days 101-120. The mean (+/-SEM) serum beta-carotene concentration for the combined beta-carotene supplemented and placebo subjects (n = 9) was not significantly reduced from that on day 1 (1.27 +/- 0.24 mumol/L) on days 60 (0.66 +/- 0.14 mumol/L) and 100 (0.91 +/- 0.38 mumol/L), but on day 120 (3.39 +/- 0.44 mumol/L) it was increased above that on days 1, 60, and 100. Maximum mitogenic proliferative responsiveness of blood lymphocytes in vitro to optimal dose phytohemagglutinin (PHA) was reduced on days 60 (P = 0.025) and 100 (P < 0.0001), but corrected itself on day 120 to a value above those on day 1 (P = 0.04), day 60 (P = 0.0001), and day 100 (P < 0.0001). Present findings show that a diet low in carotene had a suppressive effect on the maximum mitogenic proliferative responsiveness of blood lymphocytes in vitro, which was not corrected with low-dose beta-carotene supplementation but was with a carotenoid complex from vegetables rich in carotenoids.

Possible immunologic involvement of antioxidants in cancer prevention.

The people of Linxian County, China have one of the world's highest rates of esophageal cancer. Two intervention trials were conducted to determine whether supplementation with specific vitamins and minerals could lower mortality from or incidence of cancer in this population and whether supplementation with multiple vitamins and minerals would reduce esophageal and gastric cardia cancer in persons with esophageal dysplasia. About 30,000 general population (GP) subjects in the GP trial were randomly assigned to one of eight intervention groups according to a one-half replicate of a 2(4) factorial experimental design and were supplemented for 5.25 y with four combinations of micronutrients at doses from one to two times the US recommended dietary allowance (RDA). About 3000 subjects in whom dysplasia was diagnosed in the dysplasia trial were randomly assigned to groups receiving daily supplementation with 14 vitamins and 12 minerals at two to three times the US RDA or placebo for 6 y. Results of the dysplasia trial indicate that in individuals with esophageal dysplasia, micronutrient supplementation had little effect on T lymphocyte responses. In contrast, male participants in the GP trial who were supplemented with beta-carotene, vitamin E, and selenium showed significantly (P < 0.05) higher mitogenic responsiveness of T lymphocytes in vitro than those not receiving these micronutrients.

Transcutaneous electrical nerve stimulator for procedural pain associated with intravenous needlesticks.

Venipuncture continues to be considered a painful and unpleasant experience for those receiving medical treatment. A prospective study investigating whether the application of a transcutaneous electrical nerve stimulator (TENS) decreases the complaints of pain and unpleasantness with i.v. needle insertion was conducted using a group of 71 subjects who were double-blinded and randomized to one of three groups: TENS, placebo-TENS, and control. This article gives an overview of this research and describes its findings.

Managing myoclonus secondary to anoxic encephalopathy through EMG biofeedback.

Biofeedback has traditionally been used in the context of relaxation therapy along with stress management. Some recent studies have looked to extend the applicability of biofeedback by using it as a didactic tool for neuromotor rehabilitation. The present case is one in which an anoxic head-injury patient was unable to participate in transfers owing to a severe myoclonic condition. The patient was trained using an autogenic relaxation procedure along with EMG biofeedback modality to reduce the myoclonus and therefore participate actively with stand pivot transfers.

Lymphocyte responsiveness of children supplemented with vitamin A and zinc.

We sought to determine the effect of supplementation with zinc, vitamin A, or a combination of the two on proliferation of T lymphocytes to concanavalin A (ConA), tetanus toxoid (TT), or tuberculin (PPD) of children living in a region endemic for suboptimal vitamin A and zinc intake. The children (n = 140, aged 6-13 y) were randomly assigned and supplemented with either zinc (25 mg/d), vitamin A (1500 mg RE/d), zinc + vitamin A, or placebo for 6 mo. After a baseline blood collection, subjects were boosted with diphtheria-tetanus antigen. Proliferative responsiveness of T lymphocytes to ConA and TT in each treatment group (n = 35) was not different at baseline or postsupplementation. Children supplemented with zinc + vitamin A tended to show higher proliferative responsiveness of T lymphocytes to PPD than did those treated with placebo (P = 0.08). This tendency was observed in females but not in males. Increased zinc and vitamin A intake could result in health benefits for children living in regions endemic for suboptimal micronutrient nutriture.

Effect of vitamin A and zinc supplementation on the nutriture of children in Northeast Thailand.

Previous surveys suggested that young children in Northeast Thailand may benefit from vitamin A and/or zinc supplementation. One hundred thirty-three children aged 6-13 y with marginal plasma retinol (less than 1.05 mumol/L) and Zn (less than 12.2 mumol/L) concentrations participated in a double-blind study. They were randomly assigned and supplemented with either zinc (25 mg/d), vitamin A (1500 RE/d), zinc plus vitamin A, or placebo for 6 mo. Biochemical indices of vitamin A (plasma vitamin A, retinol-binding protein) and zinc status (plasma zinc, alkaline phosphatase) increased significantly. The children had adequate liver stores of vitamin A (relative dose response less than 20%). Zinc supplementation resulted in an improvement in vision restoration time (VRT) in dim light (dark adaptometry). Vitamin A and zinc synergistically normalized conjunctival epithelium as measured by conjunctival impression cytology (CIC). Both functional indices, VRT and CIC, showed significant correlations with plasma zinc and vitamin A, respectively. The data suggest that functional improvements in populations with suboptimal vitamin A and zinc nutriture can be accomplished by supplementation with less than two times the recommended dietary allowance of these nutrients.

Increased vitamin E intake restores fish-oil-induced suppressed blastogenesis of mitogen-stimulated T lymphocytes.

We sought to determine whether fish-oil supplementation would suppress blastogenesis in vitro of concanavalin A (ConA)-stimulated peripheral blood mononuclear cells (PBMCs) and, if so, whether it could be reversed with increased intake of vitamin E. Healthy males ate a controlled basal diet providing a total of 40% of energy from fat when fed in conjunction with 15 g/d of either placebo oil (PO) or fish-oil concentrate (FOC) fortified with 15 mg alpha-tocopherol/d for three periods. The subjects were supplemented with PO for 10 wk (PO), with FOC for 10 wk (FOC), and with FOC plus an additional 200 mg alpha-tocopherol/d for 8 wk (FOC+E). During FOC supplementation mitogenic responsiveness of PBMCs to ConA was suppressed, but this effect was reversed by concurrent supplementation with all-rac-alpha-tocopherol (FOC+E). There was a significant positive relationship (P less than 0.001) between plasma alpha-tocopherol concentrations and responsiveness of T lymphocytes to ConA.

Desferoxamine and iron dextran in acute Salmonella cholerae-suis infection in pigs.

Serum iron (SI)-related and hematologic changes were evaluated in a herd of weaned pigs inoculated with a strain of Salmonella cholerae-suis, causing 83% mortality within 22 days after inoculation was done. Serum iron concentrations decreased to 35% of base-line values 2 days after inoculation was done, but recovered to near base line subsequently. Total SI-binding capacity (TIBC) decreased gradually for 14 days after inoculation was done. Transferrin (TF) concentrations decreased to near half the base line throughout the postinoculation observation period. The calculated SI saturation coefficient decreased to half the base line, but recovered to or above the base-line value subsequently. Combined observations of SI, TIBC, TF, and SI saturation coefficient concentrations indicated that there was higher saturation of host iron-binding proteins and recruitment of additional iron-binding systems subsequent to 2 days after inoculation was done. Day 2 after inoculation seemed to be a critical period for host iron metabolism. Injection of supplemental iron dextran simultaneously with Salmonella infection resulted in lower mortality of iron-injected pigs (P less than 0.005). A highly significant negative correlation was observed between SI concentration and rectal temperatures after pigs were inoculated with Salmonella (r = -0.54; P less than 0.0001). Hemoglobin concentrations, mean corpuscular volume, and mean corpuscular hemoglobin were not significantly affected by Salmonella infection or iron injection concurrent with Salmonella infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of reduced food intake on polyunsaturated fatty acid metabolism in zinc-deficient rats.

The influence of reduced food intake on metabolism of liver phospholipids (PL) in zinc-deficient (ZD) rats was measured. Wealing male Long-Evans rats were fed ad libitum zinc-deficient (2 micrograms Zn/g diet) and zinc-adequate (20 micrograms Zn/g diet) diets for 21 days. A pair-fed (PF) group was included. ZD and PF rats displayed significantly increased levels of linoleic (18:2 omega 6) and dihomo-gamma-linolenic acid (20:3 omega 6). Both ZD and PF rats displayed increased levels of gamma-linolenic acid (18:3 omega 6), but the increase was significant only in PF rats. ZD and PF rats displayed decreased levels of arachidonic acid (20:4 omega 6), but the decrease was significant only in PF rats. Both ZD and PF rats displayed significantly reduced levels of 22:5 omega 6. Both ZD and PF rats displayed increased products of delta 6 desaturation and decreased products of delta 5 and delta 4 desaturation. Significantly increased products of delta 9 desaturation were noted in both ZD and PF rats. ZD and PF rats displayed significant increases in C20 elongation products. ZD and PF rats displayed significantly decreased levels of omega 6 metabolites but not total omega 6 acids. ZD rats showed significantly increased levels of total omega 3 acids and omega 3 metabolites. ZD and PF rats showed significant increases in omega 9 acids but not significant changes in omega 9 metabolites. This study does not indicate that zinc affects the delta 6 desaturase in the metabolism of essential fatty acids. The aberrations previously attributed to zinc deficiency are probably due to the accompanying decreased food intake.