A longitudinal communication approach in advanced lung cancer: A qualitative study of patients', relatives' and staff's perspectives.

Communication and the care of patients with advanced cancer are a dynamic, interactive and challenging process, often characterised in every day practice by discontinuity and lack of coordination. The objective of this study was to explore the patients' and family-caregivers' needs and preferences regarding communication, quality of life and care over the trajectory of disease. The second aim was to assess health professionals' views on a longitudinally structured, forward-thinking communication approach based on defined milestones. A qualitative approach was chosen incorporating semi-structured interviews with nine patients with metastatic lung cancer and nine relatives, and focus groups with 15 healthcare providers from different professions involved in the care of these patients. Patients and relatives described a situation of shock and coping deficits with moments of insufficient communication and lack of continuity in care. Healthcare providers reported the strong need for improvement in communication within the team and between patients and professionals and welcomed the implementation of a longitudinal communication approach. Requirements for the implementation of a longitudinal communication approach include specific communication training with focus on the process that patients and relatives are involved in. Team-building measures and the necessary flexibility to respect individuality in life should be incorporated.

[Models of communication to integrate early palliative care in thoracic oncology]. / Kommunikationsmodell zur frühen Integration der Palliativmedizin in der thorakalen Onkologie.

The recent development in optimising palliative care standards in thoracic oncology is associated with an increased demand in specialized communication skills. Standardised and integrated assessments of the palliative care need of the patient is met by limited health care resources. The model of communication described in this article emphasizes the need to structure palliative distress assessment of the patient. Communication pathways are shown as a platform to evaluate and support patient and caregivers. Standards to establish algorithms of communication in palliative care will improve the very important interaction between patient and caregivers.

[Concept for a forward-looking communication in the palliative treatment of patients with pneumological-oncological diseases prospective]. / Konzept einer vorausschauenden Kommunikation in der palliativen Behandlung von Patienten mit pneumologisch-onkologischen Erkrankungen.

The treatment and medical care of patients with lung cancer is mostly characterised and complicated by a reduced life expectancy. The lack of time can easily be the cause for various problems concerning the handling of these patients, their relatives and medical staff. A concept for opening future perspectives through standardised steps of communication could lead to a more cautious and humane relationship between physician and patient. In the case of successful realisation of this strategy, a significant enhancement of quality of life for the patient and relatives and practicability of work for the physician can be expected.

Studies on the specificity of phosphorylase kinase using peptide substrates.

The action of phosphorylase kinase on synthetic peptides is reported. These peptides are variants of the amino acid sequence. Ser-Asp-Gln-Glu-Lys-Arg-Lys-Gln-Ile-Ser-Val-Arg-Gly-Leu, found in the natural substrate, phosphorylase b. The effects of size, the cluster of basic groups at the NH2-terminal side, the phosphorylatable seryl residue, the hydrophobic groups surrounding serine, and the arginyl function at the COOH-terminal side were tested and analyzed by evaluation of the kinetic parameters, Km and Vmax. The first 6 residues were found to be nonessential, but substitution of residues in the sequence. Lys-Gln-Ile-Ser-Val-Arg, had a large effect on phosphorylation. A comparison was made between the action of nonactivated and activated phosphorylase kinase on selected peptides and phosphorylase b. Various forms of phosphorylase b were tested as substrates for cyclic AMP-dependent protein kinase in the presence of effectors and salts. Although phosphorylase would not serve as a substrate for protein kinase, the aforementioned synthetic peptide of the phosphorylase b sequence would do so, indicating that the primary sequence surrounding the phosphorylatable serine did not block phosphorylation, which suggests that higher order structural features prohibit the phosphorylation.

[The diameter of arterial and venous abdominal vessels during acute and chronic administration of nitrates. A sonographic study]. / Die Weite von arteriellen und venösen Abdominalgefässen unter akuter und chronischer Gabe von Nitraten. Eine sonographische Untersuchung.

Fourteen male patients with coronary heart disease were randomly assigned to treatment periods with isosorbide dinitrate (ISDN) 120 mg/day (6 X 20 mg) and placebo for 4 weeks each, according to a double-blind protocol with intraindividual cross-over. The luminal diameters of the superior mesenteric artery, the hepatic artery, the superior mesenteric vein and the portal vein were determined sonographically in the supine position on days 1, 14 and 28 of both treatment periods 90 min after drug intake. The measurements were repeated after 1.6 mg sublingual nitroglycerin. On day 1 of drug intake the vessel diameters increased significantly after ISDN as compared to placebo: superior mesenteric artery: +11%; hepatic artery: +26%; superior mesenteric vein: +17%; portal vein: +11% (p less than 0.05). No differences in luminal diameters between both drug regimens were found on days 14 and 28. Additional nitroglycerin caused a marked diameter increase during the placebo period (14-21%; p less than 0.001) and on days 14 and 28 of ISDN therapy, while the drug effects were absent after maximal ISDN-induced vasodilatation on day 1. Thus, nitroglycerin and isosorbide dinitrate administered acutely caused a comparable vasodilatation of arterial and venous vessels in the splanchnic region. During sustained therapy with isosorbide dinitrate the vasodilatory effects of the drug were lost. It is supposed that a decrease of blood pooling in the splanchnic region occurs during sustained ISDN therapy. Despite this tolerance development to the circulatory effects of isosorbide dinitrate, nitroglycerin remained effective with regard to arterial and venous vasodilatation.

Pyridoxal phosphate-dependent conformational states of glycogen phosphorylase as probed by interconverting enzymes.

The interaction between pyridoxal 5'-phosphate and the convertible serine of glycogen phosphorylase has been investigated by using: specific interconverting enzymes, phosphorylase kinase and phosphorylase phosphatase; effectors, glucose and glucose 6-phosphate; and a protein kinase and trypsin. Both phosphorylase kinase and phosphorylase phosphatase utilized the native protein while having little influence on the apoprotein. Removal of a peptide containing the critical serine residue gave phosphorylase b' from which the pyridoxal 5'-phosphate in phosphorylase has an important effect on enzymic interconversion.