Akademisch ausgebildete Pflegefachpersonen sind in unterschiedlichen Settings mehr und mehr gefragt. Eine Bedarfsanalyse zeigt, dass gerade in der Palliativversorgung von Menschen mit Migrationshintergrund Versorgungs- lücken existieren und vorhandene Leistungsangebote angepasst werden müssen. Der Einsatz von Advanced Practice Nurses im Kontext der kultursensiblen Palliativversorgung bietet dabei gute Lösungsansätze. Konkrete Einsatzmöglichkeiten durch explizit definierte Rollen und Aufgaben werden deutlich, hier am Beispiel von muslimischen Sterbenden. Durch die Entwicklung und Implementation von kultursensiblen Pflegekonzepten kann eine verbesserte Palliativversorgung ermöglicht werden.

Adolescents and young adults with cancer (AYA) represent a specific age cohort dealing with the disease in a stage of life characterized by development, upheavals, and establishment. The aim of this study was to point out the state of research on how AYA are affected by cancer-related fatigue (CRF). RESULTS:Twelve articles were included. CRF was found to be higher in AYA than in either of the comparison groups, healthy peers and older cancer patients. Most included studies did not measure CRF with multidimensional, fatigue-specific instruments. CONCLUSION:We found a gap in research concerning CRF in AYA. The existing findings suggest that CRF is a significant issue for AYA cancer patients. However, less is known about the prevalence, severity, and impact of CRF in AYA, and their treatment. This should be considered in future research, and risk and prevention factors should be ascertained. Multidimensional and fatigue-specific measuring tools should be used to do this.

Krebspatienten kämpfen oftmals nach den medizinischen Therapien mit Schmerzen, die auch die Lebensqualität beeinträchtigen können. In den letzten Jahren wurde die Gruppe der jungen Erwachsenen mit Krebs (AYA) zunehmend beachtet. Für die AYA gibt es bislang jedoch kaum Arbeiten, die sich mit dem Schmerzerleben auseinandersetzen.

After having completed medical treatment cancer patients often suffer from pain that can impair the quality of life. While young adolescents and adults (AYA) with cancer have become the focus of research during recent years, literature on the prevalence, quality and relief of pain in AYA patients is lacking.This study investigated psychosocial data on pain experienced by AYA patients (e.g. prevalence, type, distress, anxiety and need for support) and the association with the quality of life.Standardized and validated questionnaires were used for assessing pain and quality of life in AYA patients defined as the patient group between 18 and 39 years. Calculated regression models were summarized in a pathway model.Out of 117 AYA patients (66 % women) 45 (39 %) suffered from pain and of these 73 % felt impaired due to the pain, 58 (50 %) had a fear of pain and 21 (20 %) reported a need for support. The severity of pain had a negative influence on physical functioning (beta = -0.335) and health-related satisfaction (beta = -0.415). Regarding the quality of life, 105 patients (90 %) were overall satisfied with their life. Dissatisfaction was reported in the areas of occupation (39.34 %), ability to relax (36.31 %), physical performance (34.29 %), income (32.27 %) and partnership/sexuality (29.25 %).This study provides evidence that pain plays a relevant role for AYA patients after the end of medical treatment. A substantial proportion of AYA patients reported the need for support so that the question arises whether medical pain management is sufficient, particularly as pain was associated with impairment and strongly negatively associated with health-related satisfaction.

The dating of bruises can be of crucial interest in clinical forensic medicine, but the macroscopic or photographic evaluation of a bruise has not been regarded as reliable. Several methods have thus been regularly evaluated for this purpose, with reflectance spectrometry yielding promising results. The objective of this study is to evaluate the value of a bilirubinometer as a tool for dating bruises on living victims.A clinical follow-up was carried out on patients presenting a bruise with a known onset. Using a bilirubinometer, we obtained daily measurements of the bruise (bili-bruise) and of healthy skin (bili-skin). Potential confounding factors were collected: age, sex, body mass index, trauma mechanism and Fitzpatrick skin phototype.We followed 20 patients for a total of 88 measurements of bruises. Bili-skin values showed significant differences according to skin phototype. Differences between the bili-bruise and bili-skin values (Δ-bili) followed an increase phase, peaking between 3 and 5 days, and then there was a decrease phase. No significant Δ-bili value differences were observed based on the suspected confounding factors.Our results are in favour of a peak Δ-bili value generally at day 4 or 5 post-trauma. Notably, decreasing values were not observed before day 3. Decreasing Δ-bili values would then indicate a bruise resulting from an injury formed at least 3 days before the first measurement. Complementary work confirming such data would enable improvement of the performance of bruise dating in forensic medicine.

OBJECTIVES The early discharge of neonates from hospitals makes transcutaneous measurement of total bilirubin concentration a useful tool to monitor neonatal jaundice. The objectives of this study were to determine whether 1) transcutaneous bilirubin (TcB) measurement, as performed using BiliCheck (BC), correlates with total serum bilirubin (TSB) levels, measured with standard laboratory methods and with high-pressure liquid chromatography (HPLC-B); 2) infant race, gestational age, postnatal age, or body weight interferes with the measurement of TcB levels in newborn infants; 3) the variability of the TcB measurement is comparable to the variability of TSB measurements; and 4) TcB measurements obtained from the forehead (BCF) and sternum (BCS) generate comparable results. STUDY DESIGN Newborn infants who were <28 days and >30 weeks' gestational age and who underwent tests for TSB as part of their normal care in 6 different European hospitals were studied. A total of 210 infants were enrolled in the study, 35 at each site. Near simultaneous (within +/- 30 minutes) blood collection for TSB and BCF and BCS measurements were performed. TSB levels were determined by the serum bilirubin method in use at each site, and all HPLC-B determinations were made at the same, independent laboratory. RESULTS The study group consisted of 140 white, 31 Asian, 14 Hispanic, 9 African, and another 16 newborns of different races. The correlation coefficient (r) between BCF and HPLC-B was 0.890 (95% confidence interval = 0.858-0.915). BCF and BCS generated similar results (r value = 0.890 for BCF and 0.881 for BCS), even if BCS slightly overestimated (mean error = -0.04 mg/dL) and BCF slightly underestimated (mean error = 0.96 mg/dL) in comparison with HPLC-B. Analysis of covariance demonstrated that BC accuracy was independent of race, birth weight, gestational age, and postnatal age of the newborn. Receiver operating characteristic curves were evaluated for BCF and TSB, each compared with HPLC-B. With the use of a cutoff point for HPLC-B of 13 mg/dL (222 micromol/L) and a cutoff of 11 mg/dL on the BCF and TSB, similar sensitivity/specificity (93%/73% for BCF, 95%/76% for TSB) were observed. The use of a cutoff point for HPLC-B of 17 mg/dL (290 micromol/L) and 14 mg/dL (240 micromol/L) for BCF and TSB also produced similar sensitivity/specificity (90%/87% for the BC and 87%/83% for TSB). CONCLUSIONS Because the correlation coefficient for HPLC-B and BCF is very similar to that found for HPLC-B and laboratory TSB, BC could be used not only as a screening device but also as a reliable substitute of TSB determination. At higher levels of TSB, in which phototherapy and/or exchange transfusion might be considered, BC performed slightly better than the laboratory. The accuracy and precision of the TcB measurement in this study was observed to be comparable to the standard of care laboratory test.

Anti-D prophylaxis is currently applied in France after birth of an RhD positive infant, after interruption of pregnancy and after some antenatal immunizing events (amniocentesis...). However this program does not cover all the prenatal exposures to fetal RhD antigen, and maternal Rh immunization continues to occur. DNA RhD genotyping of the fetus is now reliably performed on amniotic fluid, and pre diagnostic studies on fetal DNA extracted from maternal plasma are promising. The widespread use of fetal RhD genotyping on maternal blood would allow the antenatal administration of Rh immunoglobuline in all Rh negative patients bearing an Rh positive fetus, insofar as it would preclude exposing the other Rh negative patients to the above plasma derived and rather expensive blood product.

BACKGROUND: Because GB virus type C(GBV‐C)/HGV (GBV‐C/HGV) is blood‐borne and sexually transmitted, persons at risk of infection with such viruses have a high prevalence of GBV‐C/HGV markers. However, adults with no apparent risk factors, such as blood donors, frequently are positive for GBV‐C/HGV markers. Mother‐to‐infant transmission could explain this high prevalence, but it has been studied only through small series of GBV‐C/HGV‐infected mothers co‐infected with HCV or HIV.STUDY DESIGN AND METHODS: To determine the rate of mother‐to‐infant transmission of GBV‐C/HGV RNA in women who are HCV‐ or HIV‐negative, a prospective study was performed in a cohort of 288 mothers screened for viral RNA and in the infants born to GBV‐C/HGV‐infected mothers.RESULTS: Thirteen mothers (4.5%) were found positive for GBV‐C/HGV RNA. Of the infants in whom at least one blood sample was collected between the third and the ninth months of life, 89 percent were positive for viral RNA. The majority of these newborns were negative for GBV‐C/HGV RNA at birth and positive after the third month. The viral RNA titers of infants born to GBV‐C/HGV‐infected mothers appeared as elevated as those of their mothers. All the GBV‐C/HGV‐infected infants remained positive for viral RNA during the entire study period. No clinical events possibly linked to a primary GBV‐C/HGV infection were reported in infants. Serum ALT level and blood count remained within normal values throughout the follow‐up of all GBV‐C/HGV‐infected infants.CONCLUSION: The frequency of mother‐to‐infant GBV‐C/HGV transmission is elevated and could explain the high prevalence of GBV‐C/HGV markers (viral RNA and E2 antibody) in adults at low risk for blood‐borne or sexually transmitted viruses, such as blood donors.

PURPOSE:The necessity of saving blood products has established the practice of exchange transfusion (ET) with reconstituted blood in newborns. The aim of this retrospective study was to evaluate the indications and the practice of this technique at the Perinatal Hemobiology Centre (Paris, France).METHODS:The records of intervention allowed us to review the etiologic categories for neonates having undergone exchange transfusion with reconstituted blood, the dosages used (bilirubin, hemoglobin), and the other main parameters of ET.RESULTS:Sixty ETs were performed in 48 newborns between the 1st July 1996 and the 1st July 1998. Twenty-seven with Rh hemolytic disease had 39 ETs (19 for hyperbilirubinemia, 12 for anemia, and eight for both), whereas ten out of 12 repeated ETs were indicated for hyperbilirubinemia (six of these cases were in newborns weighing > or = 2500 g and after a volume exchange < or = 1 blood mass [range 0.72-1.0] at the last ET). Twenty-one cases showed other diseases: six of them had anemia, nine had hyperbilirubinemia, and seven showed disseminated coagulopathy. The tolerance of ET was poor in 24% infants in this group.CONCLUSIONS:The volume of 1.3 blood mass for ET is sufficient for the majority of cases with hyperbilirubinemia, allowing transfusional savings in comparison with the previous recommendation of two blood volumes. Exact labeling of the content of units of packed red cells and plasma is essential to fulfill the volume and hematocrit requirements in every case.