Psychosocial distress and desire for support among skin cancer patients - impact of treatment setting.

BACKGROUND: Diagnosis and treatment of malignancies are frequently associated with a variety of problems for affected individuals and their relatives. In order to ensure adequate psycho-oncological and social care, it is recommended to routinely assess patients' psychosocial distress. While psychosocial services for inpatients have been expanded in recent years, the outpatient care structure in terms of psycho-oncological support is far from satisfactory, especially in Mecklenburg-Western Pomerania. We therefore set out to investigate the following questions: Does the need for psychosocial care vary in relation to (a) the treatment setting (inpatients vs. outpatients) and (b) the diagnosis? (c) Do patients experiencing psychological distress desire support? PATIENTS AND METHODS: We asked both inpatients and outpatients to rate their psychosocial situation using the Hornheide Questionnaire. Patients were also asked about their desire for psychological support and the preferred contact person. RESULTS: (a) The treatment setting had no impact on the need for psychosocial care and the desire for support. (b) Depending on the type of skin cancer, there were significant differences in the need for such care among the 251 patients surveyed. (c) Despite a certain discrepancy, there was a significant correlation between psychosocial distress (39.0 %; n = 98/251) and desire for support (14.3 %; n = 35/245). (d) Patients experiencing distress primarily chose physicians (n = 21) and psychologists (n = 20) as potential contact persons. CONCLUSIONS: (1) In addition to the level of distress, the desire for support should be inquired. (2) Recommendations by physicians represent an important means of access to psycho-oncological services. (3) Services for outpatient support should be expanded.

Maggots as potential vector for pathogen transmission and consequences for infection control in waste management.

BACKGROUND AND AIMS: Debridement therapy with sterile bred larvae in non-healing wounds is a widely accepted safe and efficient treatment modality. However, during application in the contaminated wound bed microbial contamination with potential microbial pathogen spread after escape from the wound or after unreliable disposal procedure may happen, particularly in the case of not using bio-bags. The aims of this work were first to investigate the release of ingested bacteria into the environment by maggots and second to examine the common practice of freezing the maggots after use and/or disposal in trash-bags. Potential methods for hygienic safe disposal of used maggots should be deduced. METHODS: First, Maggots were contaminated with S. aureus by allowing them to crawl over an agar surface completely covered with bacterial growth over 24 h at 37°C. After external disinfection maggots were transferred onto sterile Columbia agar plates and shedding of S. aureus was visualized. Second, maggots were frozen at -20°C for 1, 2, 5, 10, 30, and 60 min. After exposure, the larvae were transferred onto Columbia blood agar with consecutive incubation at 37°C over 48 h. The larvae were analyzed visually for mobility and eating activities. The frozen bodies of dead larvae were examined for viable bacteria. RESULTS: We could demonstrate that maggots release formerly ingested pathogens (S. aureus). Freezing at -20°C for at least 60 min was able to kill all maggots, however the contaminant bacteria inside could survive. CONCLUSION: Since freezing is apparently able to kill maggots but not to reliabely inactivate the ingested bacterial pathogens, we recommend the disposal of free-range larvae in screw cap vials after use to achieve full hygienic control.

Development of a mobile teledermatology system.

OBJECTIVE: The increasing number of elderly and chronically ill patients is currently stressing healthcare systems. One of the solutions for reaching an economically and socially viable solution is exploiting the benefits of modern technologies. This article presents an innovative mobile teledermatology program for assisting both the therapy and the aftercare of patients suffering from skin diseases. SUBJECTS AND METHODS: The system is based on store-and-forward teledermatology and consists of two main components: (1) an application implemented on the mobile phone in order to enable patients to transmit both skin image data and biofeedback information and (2) an online portal for the care providers. The key idea is to ensure a sufficient involvement of the patients in the therapy process and to motivate them through their active cooperation. RESULTS: Smartphone applications with features as well as the online Web-based portal for medical care providers are presented. The entire system is embedded on a secure telematics platform. The system was tested at the Clinic for Skin Diseases of the University of Greifswald, Greifswald, Germany, by patients with skin diseases such as ulcus cruris, postoperative wound documentation, eczema, psoriasis, and pemphigus for a period of 1 year. Medical care providers could also analyze patients' data from the developed online Web-based application during that test period. CONCLUSIONS: Positive feedback from both medical care providers and patients confirms a high potential for mobile teledermatology as a means of dermatological healthcare delivery.

Classification of compression bandages: practical aspects.

BACKGROUND: Compression bandages appear to be simple medical devices. However, there is a lack of agreement over their classification and confusion over the use of important terms such as elastic, inelastic, and stiffness. OBJECTIVES: The objectives were to propose terms to describe both simple and complex compression bandage systems and to offer classification based on in vivo measurements of subbandage pressure and stiffness. METHODS: A consensus meeting of experts including members from medical professions and from companies producing compression products discussed a proposal that was sent out beforehand and agreed on by the authors after correction. RESULTS: Pressure, layers, components, and elastic properties (P-LA-C-E) are the important characteristics of compression bandages. Based on simple in vivo measurements, pressure ranges and elastic properties of different bandage systems can be described. Descriptions of composite bandages should also report the number of layers of bandage material applied to the leg and the components that have been used to create the final bandage system. CONCLUSION: Future descriptions of compression bandages should include the subbandage pressure range measured in the medial gaiter area, the number of layers, and a specification of the bandage components and of the elastic property (stiffness) of the final bandage.