"SpezPat"- common advance directives versus disease-centred advance directives: a randomised controlled pilot study on the impact on physicians' understanding of non-small cell lung cancer patients' end-of-life decisions.

BACKGROUND: The advance directive represents patients' health care choices and fosters patients' autonomy. Nevertheless, understanding patients' wishes based on the information provided in advance directives remains a challenge for health care providers. Based on the ethical premises of positive obligation to autonomy, an advanced directive that is disease-centred and details potential problems and complications of the disease should help health care providers correctly understand patients' wishes. To test this hypothesis, a pilot-study was conducted to investigate whether physicians could make the correct end-of-life decision for their patients when patients used a disease-centred advance directive compared to a common advance directive.  MATERIAL AND METHODS: A randomised, controlled, prospective pilot study was designed that included patients with non-small cell lung cancer (NSCLC) stage VI from the Department of Haematology and Medical Oncology, University Medical Centre, Goettingen. Patients were randomised into intervention and control groups. The control group received a common advance directive, and the intervention group received a disease-centred advance directive. Both groups filled out their advance directives and returned them. Subsequently, patients were asked to complete nine medical scenarios with different treatment decisions. For each scenario the patients had to decide whether they wanted to receive treatment on a 5-point Likert scale. Four physicians were given the same scenarios and asked to decide on the treatment according to the patients' wishes as stated in their advance directives. The answers by patients and physicians were then compared to establish whether physicians had made the correct assumptions. RESULTS: Recruitment was stopped prior to reaching anticipated sample target. 15 patients with stage IV NSCLC completed the study, 9 patients were randomised into the control group and 6 patients in the intervention group. A total of 135 decisions were evaluated. The concordance between physicians' and patients' answers, was 0.83 (95%-CI 0.71-0.91) in the intervention group, compared to 0.60 (95%-CI 0.48-0.70) in the control group, and the difference between the two groups was statistically significant (p = 0.005). CONCLUSION: This pilot study shows that disease-centred advance directives help physicians understand their NSCLC patients' wishes more precisely and make treatment choices according to these wishes. TRIAL REGISTRATION: The study is registered at the German Clinical Trial Register (no. DRKS00017580, registration date 27/08/2019).

Using Instagram to Enhance a Hematology and Oncology Teaching Module During the COVID-19 Pandemic: Cross-sectional Study.

BACKGROUND: The COVID-19 pandemic necessitated the rapid expansion of novel tools for digital medical education. At our university medical center, an Instagram account was developed as a tool for medical education and used for the first time as a supplement to the hematology and medical oncology teaching module of 2020/2021. OBJECTIVE: We aimed to evaluate the acceptance and role of Instagram as a novel teaching format in the education of medical students in hematology and medical oncology in the German medical curriculum. METHODS: To investigate the role of Instagram in student education of hematology and medical oncology, an Instagram account was developed as a tie-in for the teaching module of 2020/21. The account was launched at the beginning of the teaching module, and 43 posts were added over the 47 days of the teaching module (at least 1 post per day). Five categories for the post content were established: (1) engagement, (2) self-awareness, (3) everyday clinical life combined with teaching aids, (4) teaching aids, and (5) scientific resources. Student interaction with the posts was measured based on overall subscription, "likes," comments, and polls. Approval to conduct this retrospective study was obtained from the local ethics commission of the University Medical Center Goettingen. RESULTS: Of 164 medical students, 119 (72.6%) subscribed to the Instagram account, showing high acceptance and interest in the use of Instagram for medical education. The 43 posts generated 325 interactions. The highest number of interactions was observed for the category of engagement (mean 15.17 interactions, SD 5.01), followed by self-awareness (mean 14 interactions, SD 7.79). With an average of 7.3 likes per post, overall interaction was relatively low. However, although the category of scientific resources garnered the fewest likes (mean 1.86, SD 1.81), 66% (27/41) of the student participants who answered the related Instagram poll question were interested in studies and reviews, suggesting that although likes aid the estimation of a general trend of interest, there are facets to interest that cannot be represented by likes. Interaction significantly differed between posting categories (P<.001, Welch analysis of variance). Comparing the first category (engagement) with categories 3 to 5 showed a significant difference (Student t test with the Welch correction; category 1 vs 3, P=.01; category 1 vs 4, P=.01; category 1 vs 5, P=.001). CONCLUSIONS: Instagram showed high acceptance among medical students participating in the hematology and oncology teaching curriculum. Students were most interested in posts on routine clinical life, self-care topics, and memory aids. More studies need to be conducted to comprehend the use of Instagram in medical education and to define the role Instagram will play in the future. Furthermore, evaluation guidelines and tools need to be developed.

Sarcoidosis Following Hematopoietic Stem Cell Transplantation: Clinical Characteristics and HLA Associations.

Purpose: Extrinsic factors and genetic predisposition contribute to the etiology of sarcoidosis, converging in a phenotype of altered immune response associated with multisystemic inflammatory granulomatous tissue infiltration. Immunological reconstitution after hematopoietic stem cell transplantation (HSCT) may represent a unique window for the pathogenesis of the disease. We describe the incidence, clinicopathological features, and HLA associations of sarcoidosis after HSCT in a single-center cohort of patients, together with data from previously published cases. Methods: We retrospectively analyzed clinical characteristics and HLA haplotypes from allogeneic (allo) or autologous (auto) HSCT patients from January 2001 through May 2021 at the University Medicine Goettingen (UMG), and data from previously published cases. Results: A total number of 19 patients was identified. These included 4 patients from our center (3 allo HSCT and 1 auto HSCT) and 15 patients from the literature review. Thirteen patients had received an allo HSCT, and six patients had received an auto HSCT. Sarcoidosis occurred after a median interval of 20 (after allo HSCT) and 7 (after auto HSCT) months, respectively. The predominant HLA allele associated with sarcoidosis was HLA DRB1*03:01. Sarcoidosis involved the respiratory tract in 15 patients (three unknown, one without pulmonary involvement), and it was associated with graft-versus-host disease in 7 of 13 patients receiving allo HSCT. None of the donors or patients had a history of sarcoidosis before transplantation. Disease manifestations resolved with standard glucocorticoid treatment without long-term sequelae. Conclusion: Sarcoidosis may occur at low frequency during reconstitution of the immune system after HSCT. HLA allele associations reflect the associations observed in the general population, particularly with DRB1*03:01. Further insights into the interplay between Tcell reconstitution and the development of sarcoidosis could also provide novel approaches to an improved understanding of the pathogenesis in sarcoidosis.