Introducing a standardized assessment of patients' interest in and usage of CAM in routine cancer care: chances and risks from patients' and physicians' point of view.

BACKGROUND: Cancer patients often use complementary and alternative medicine (CAM), however, standardized assessment in clinical routine is missing. The aim of this study was to evaluate a screening questionnaire on CAM usage that was published in the S3 Guideline Complementary Medicine in the Treatment of Oncological Patients. METHODS: We developed a survey questionnaire to assess the practicability of the guideline questionnaire and communication on CAM between health care providers (HCPs) and patients. We collected 258 guideline questionnaires and 116 survey questionnaires from ten clinics and held twelve semi-structured interviews with HCPs. RESULTS: 85% used at least one of the listed CAM methods, 54 participants (N = 77) never disclosed usage to a physician. The most frequently used CAM methods were physical activity (76.4%) and vitamin D (46.4%). 25.2% used at least one method, that was labeled risky by the guideline. 53.4% did not know of CAM's risk of interactions and side effects. Introducing the guideline questionnaire in routine cancer care increased the rate of patients talking to an HCP regarding CAM significantly from 35.5 to 87.3%. The HCPs stated positive effects as an initiation of conversation, increased safety within CAM usage and patients feeling thankful and taken seriously. However, due to the limited amount of time available for discussions on CAM, generalized distribution to all patients was not feasible. CONCLUSION: Institutions should focus on implementing standard procedures and resources that help HCPs discuss CAM on a regular basis. HCPs should meet the patient's demands for CAM counseling and make sure they are equipped professionally.

Differential reflex adaptations following sensorimotor and strength training in young elite athletes.

In young elite athletes the influence of a sensorimotor training (SMT = balance training) on strength, jump height and spinal reflex excitability was compared with adaptations induced by strength training (ST). Seventeen athletes were randomly assigned to either a SMT or a ST group. Before and after 6 weeks of training, maximal isometric strength (MVC) and rate of force development (RFD (max)) were determined. Changes in jump height and EMG activity were assessed during squat- (SJ), countermovement- (CMJ) and drop-jump (DJ). To evaluate neural adaptations, H-reflex recruitment was recorded at rest and during dynamic activation of the plantarflexors following stance perturbation. MVC was enhanced after ST but not influenced by SMT. RFD (max) was not affected by any training. Both SMT and ST significantly improved jump performance in SJ, CMJ, and DJ. Maximum H-reflex to maximum M-wave ratios (H (max)/M (max)-ratios) at rest remained unchanged. During stance perturbation, H (max)/M (max)-ratios were significantly reduced following SMT whereas ST augmented H (max)/M (max)-ratios (p < 0.05). In contrast to other studies, no changes in RFD were found. This may be explained by methodological and/or training specific differences. However, both SMT and ST improved jump performance in well trained young athletes but induced opposing adaptations of the H (max)/M (max)-ratio when measured during dynamic contractions. These adaptations were task-specific as indicated by the unchanged reflexes at rest. Decreased spinal excitability following SMT was interpreted as the attempt to improve movement control, whereas augmented excitability following ST accounts for the effort to enhance motoneuron output. Functionally, our results emphasise that SMT is not only beneficial for prevention and rehabilitation but also improves athletic performance.

Fluorescein angiography in syphilitic retinal vasculitis.

A case of ocular syphilis with severe ischemic retinopathy, rubeosis iridis and secondary glaucoma is described. Fluorescein angiography revealed a complete blockage of all the vessels around the macula, with dye leakage from numerous bifurcations of veins and an infiltrative mass in the macular area of both eyes. Combined treatment with steroids and penicillin brought no improvement in this condition of severe, ischemic ophthalmia.