Dalbyrichard0895
The delegation of traditional GP tasks to qualified medical assistants (MFA) includes several modalities based on extended qualification curricula known as "Nicht-ärztliche Praxisassistentin" (NäPa) [non-physician practice assistant], also known as the "Entlastende Versorgungsassistentin" (EVA) and the "Versorgungsassistentin in der Hausarztpraxis" (VERAH and VERAH Plus) [professional healthcare assistants in the family practice]. Delegation to MFA has gained importance in recent years due to an increasing workload of general practitioners in Germany.
This article examines the characteristics of general practitioners (GPs) currently delegating activities to MFAs with and without extended qualification based on the three mentioned modalities (EVA, VERAH and VERAH Plus). In addition, we explore whether the delegated activities are delivered in the office, at the patient's home or in the nursing home and how GPs perceived the potential of future delegation.
Between April and August 2016, we conducted an an supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.
GPs benefit from delegating to MFA with extended qualification as shown by the associated added values and setting of deployment for delivery of tasks. Delegation to non-medical staff should be considered by more GPs as a means of supporting healthcare delivery. In addition to legal changes, further procedures are needed to encourage GPs to get more actively involved with the issue of delegation and consider to further develop the competence of their staff and deploy them accordingly.Advances in surgical procedures, technology, and immune suppression have transformed organ transplantation. However, the metabolic changes that occur during organ retrieval, storage, and implantation have been relatively neglected since the developments many decades ago of cold storage organ preservation solutions. In this review we discuss how the metabolic changes that occur within the organ during transplantation, particularly those associated with mitochondria, may contribute to the outcome. We show how a better understanding of these processes can lead to changes in surgical practice and the development of new drug classes to improve the function and longevity of transplanted grafts, while increasing the pool of organs available for transplantation.
Preoperative grading of pancreatic neuroendocrine tumors (PanNET) is challenging. The aim of this study was to prospectively evaluate the use of a 25-gauge needle with a core trap for diagnosis and grading of PanNET.
This multicenter prospective trial was registered with the University Hospital Medical Information Network (UMIN000021409). Consecutive patients with suspected PanNET between June 2016 and November 2017 were enrolled. All patients underwent endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) using a 25-gauge needle with a core trap. Samples obtained after the first needle pass were used for central pathological review. EUS-FNB was evaluated in terms of (i) technical success rate, (ii) adequacy for histological evaluation, (iii) complication rate during the procedure, and (iv) concordance between PanNET grading on EUS-FNB and that after analysis of the resected tumor.
Fifty-two patients were enrolled. Of the 36/52 patients who underwent surgical resection, 31 were finally diagnosed with PanNET and were eligible for analysis. The technical success rate of EUS-FNB was 100%. The rate of adequacy for histological evaluation was 90.3%. There were no complications related to EUS-FNB. The concordance rate between PanNET grading on EUS-FNB and that after analysis of the resected tumor was 82.6% (95% confidence interval=61.22-95.05, P=0.579).
EUS-FNB using a 25-gauge needle with a core trap is feasible, providing histological samples are of sufficient quality for diagnosis and grading of PanNET.
EUS-FNB using a 25-gauge needle with a core trap is feasible, providing histological samples are of sufficient quality for diagnosis and grading of PanNET.
Pancreatic cancer remains one of the most lethal cancers.
This study aimed to analyze T cell-related biomarkers and their molecular network in pancreatic cancer.
RNAseq sequencing data and clinical data of pancreatic cancer were obtained from TCGA database. The STromal and Immune cells in MAlignant Tumours using Expression data (ESTIMATE) algorithm was used to screen the DEGs related to the tumor immune cells. The pearson correlation analysis were used to analyze the relationships between DEGs and T cells. selleck Additionally, the T cell-related DEGs were subjected to protein-protein interaction, competing endogenous RNA (ceRNA), and chemical small molecule-target network construction. Furthermore, the prognosis-associated DEGs were screened.
A total of 412 stromal score-associated and 312 immune score-associated DEGs were obtained. From these DEGs, 50 CD4
T cell-related genes and 13 CD8
T cell-related genes were selected. The PPI networks associated with immune cell-related genes were constructed and found that CD22, SELL, and OLR1 had higher degrees in the PPI network. The number of ceRNA regulatory relation pairs obtained from CD4
T cells and CD8
T cells were 59 and 48, respectively. Additionally, both CD4
T cell- and CD8
T cell-related genes predicted 29 small molecules. CXCL9 and GIMAP7 were screened out from CD4
T cell-related genes, which were related with the survival of pancreatic cancer.
We mapped T cell-related gene profile in pancreatic cancer and constructed their potential regulatory network.
We mapped T cell-related gene profile in pancreatic cancer and constructed their potential regulatory network.
Pancreatic ductal adenocarcinoma (PDAC) is frequently associated with severe pain. Given the almost inevitably fatal nature of the disease, pain control is crucial. However, data on quality of pain management in PDAC is scarce.
This is a multi-center, prospective study to evaluate the quality of pain management in PDAC. Insufficient pain treatment (undertreatment) was prevalent if there was an incongruence between the patients level of pain and the potency of analgesic drug therapy. Determinants of pain and undertreatment were identified using multivariable logistic regression.
139 patients with histologically confirmed PDAC were analyzed. The prevalence of pain was 63%, with approximately one third of the patients grading their pain as moderate to severe. Palliative stage (OR 3.37, 95%CI 1.23-9.21, p=0.018) and localization of the primary tumor in the body or tail (OR 2.57, 95%CI 1.05-6.31, p=0.039) were independent determinants of pain. Of those reporting pain, 60% were undertreated and in 89% pain interfered with activities and emotions.
