Objective: This explorative study aimed to determine the extent of psychological burden in social workers working with traumatized refugees. In addition, distressing and helpful factors determining the psychosocial burden were to be identified and described. Methods: Cross-sectional, mixed method design using quantitative and qualitative methods. The quantitative part included the Perceived Stress Questionnaire (PSQ) and items to assess specific factors of the working-context. The qualitative part is based on 5 focus groupdiscussions and 16 individual interviews. Evaluation was carried out using qualitative content analysis (QCA) including cross-analysis along the subscales of the PSQ to organise the qualitative material. Results: N = 54 social workers completed the questionnaire. High scores were found for all subscales of the PSQ. The distressing factor rated the highest was need of interpreters to communicate (M = 5.1, SD = 1.71), the helpful factor rated the highest was communication skills (M = 6.35, SD = 0.73). In the QCA, aspects of distressing and helpful factors were identified and further detailed. Conclusion: According to the here presented study results, the psychological burdens of social workers working with refugees seem to be high. The impact of distressing factors such as working with interpreters and exposure to trauma content or PTSD symptoms might be reduced by offering specific education and supervision. The individual extent of psychological burden should be considered and (re-)evaluated on a regular basis as secondary prevention. Helpful factors like self-care, teamwork, networking and cooperation are evident and should be supported by implementing professional and psychological support.

Objective: Chronic pain in patients with posttraumatic stress disorder (PTSD) is a frequent symptom and a complicating factor in the treatment of patients. The study' purpose is to systematically review the scientific literature on patients' characteristics and the effects of specific interventions implemented for the treatment of chronic pain in traumatized refugees. Method: A systematic search of the current literature was conducted in PubMed and Web of Science, from 1996 to 2017. A structured screening process in accordance with the PRISMA-statement was used with eligibility criteria based on the modified PICOS-criteria including refugees with chronic pain and diagnosed PTSD to investigate sample size, gender, country of origin, residential status, pain locations, predictors and correlations and type and efficacy of specific interventions. Results: The initial search resulted in a total of 2169 references, leading to 15 included studies. Most frequently, patients reported headaches, backaches, and pain in the arms and legs. Pain symptoms were associated with higher age, female gender, general living difficulties and PTSD symptoms. Cognitive behavioral therapy (CBT) and, Narrative Exposure Therapy (NET) with biofeedback, manualized trauma psychotherapy, Traditional Chinese Medicine (TCM) and Emotional Freedom Techniques were evaluated as specific interventions, resulting in positive outcomes for both pain severity and PTSD symptoms. Conclusions: To date, the existing literature shows scarce evidence evaluating specific interventions that address the needs of traumatized refugees with chronic pain. However, the current reported evidence allows for a preliminary evaluation of the characterizations of patient dimensions as well as promising results found in intervention studies.

Background and Objectives It has been reported that immature platelets may indicate imminent platelet (PLT) recovery following intensive chemotherapy and/or haematopoietic stem cell transplantation with the perspective to withhold unnecessary transfusions. The objective of our prospective study was to test immature PLTs as measured by two haematology analysers to predict PLT recovery.Material and Methods This study monitored 51 courses of severe thrombocytopenia after chemotherapy in 35 adult haematology/oncology patients starting at a PLT count < 70 x 10(9)/l until PLT recovery (>20 x 10(9)/l) or discharge from hospital. Immature platelets as measured by immature platelet fraction (IPF) (Sysmex XE-5000) and retPLT (Abbott CD-Sapphire) as well as reticulocyte and leucocyte count were evaluated regarding their usefulness to predict PLT recovery. Furthermore, the influence of platelet concentrate (PC) transfusions upon IPF and retPLT was assessed.Results With beginning of thrombocytopenia, most patients demonstrated elevated IPF% (median 8.6%) and retPLT% (median 6.8%). These elevated values significantly dropped after transfusions of PCs. IPF and retPLT values during nadir and at imminent PLT recovery were largely overlapping and receiver operating characteristics analysis demonstrated poor separation between both clinical situations. A reasonable cut-off could not be established to prospectively predict imminent PLT recovery for either of the parameters investigated.Conclusion Measurements of IPF and retPLT lack predictive power regarding imminent PLT recovery in patients with severe thrombocytopenia following intensive chemotherapy. Decisions regarding prophylactic PC transfusions should not be based on these parameters.

BACKGROUND:Oral anticoagulation with dabigatran was shown to be effective for stroke prevention in patients with nonvalvular atrial fibrillation without the need for laboratory monitoring. However, a recent publication based on data of the Randomized Evaluation of Long-Term Anticoagulation Therapy study reported that ischemic stroke and bleeding outcomes are correlated with dabigatran plasma concentration (DPC). DPC was determined at a prespecified time point and correlated with cardiovascular events at any time during follow-up. Because of the known variability of DPC, among others depending on renal function, this approach might compromise data evaluation. We report on dabigatran plasma levels in acute cerebrovascular events. METHODS:Consecutive patients with acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) while taking dabigatran were retrospectively identified if admission DPC was available. DPC was determined using the diluted thrombin time (Hemoclot (HYPHEN BioMed, Neuville sur Oise, France)). Creatinine clearance (CrCl) was determined by measuring creatinine in plasma and 24-hour urine. RESULTS:Fifteen AIS and 4 ICH patients were included. Median DPC on admission was significantly higher in ICH patients than in AIS patients (135 ng/mL [interquartile range {IQR} 79-218] and 69.1 ng/mL [IQR 20.6-85.0], respectively; P = .035). Increased CrCl (values above published normal range) was correlated with lower median DPC (60 ng/mL [IQR 10-69] versus 100 ng/mL [IQR 79-157] in patients with normal CrCl, P = .01). CONCLUSIONS:Higher DPC was found in ICH patients than in AIS patients in temporal proximity to the event. Both decreased and increased renal functions seem to have an important influence on DPC.

ThromboLUX (TLX)‐Score was compared with hypotonic shock response (HSR) and extent of shape change (ESC) in 99 samples from 42 platelet concentrates. Tests were performed in parallel and duplicate. Mean values for TLX Score, HSR and ESC were 30·3 ± 3·8%, 69·0 ± 12·2% and 23·2 ± 4·9%, respectively. We found no significant correlation between TLX Score and HSR or ESC (r = −0·158, P = 0·118 and r = −115, P = 0·255, respectively), whereas HSR and ESC correlated significantly (r = 0·351, P < 0·001). As TLX Score did not show significant correlation with HSR and ESC, the value of TLX for platelet quality testing remains unclear. Studies comparing these parameters with transfusion outcome are needed.

P. F. van der Meer, L. J. Dumont, M. Lozano, N. Bondar, J. Wong, S. Ismay, J. Pink, W. Nussbaumer, J. Coene, H. B. Feys, V. Compernolle, D. V. Devine, D. Howe, C. K. Lin, J. Sun, J. Ringwald, E. F. Strasser, R. Eckstein, A. Seltsam, P. Perseghin, P. Proserpio, S. Wakamoto, M. Akino, S. Takamoto, K. Tadokoro, D. Teo, P. H. Shu, S. S. Chua, T. Jimenez-Marco, J. Cid, E. Castro, I. Mu~ noz, H. Gulliksson, P. Sandgren, S. Thomas, J. Petrik, K. McColl, H. Kamel, J. Dugger, J. D. Sweeney, J. B. Gorlin, L. J. Sutor, D. Heath & M. H. Sayers.

Background: Cancer patients suffer from severe distress. About one third show mental comorbidities. Nevertheless, there is no common agreement on how to measure distress or identify patients in need for psychooncological services using screening questionnaires.Patients and methods: A sample of N=206 patients with confirmed breast cancer, being inpatient for surgical treatment, filled in distress assessment instruments: Distress Thermometer, Hospital Anxiety and Depression Scale, Patient Health Questionnaire 2, Hornheider Screening Instrument and parts of the EORTC-QLQ-C30. Additionally, they were asked for their subjective need for psychooncological counselling.Results: The correlation between the assessment instruments is low to medium. The number of patients above the cut-off criteria varies quite a lot according to the instrument (10% to 66%). Therefore, the congruence between the instruments' indications is quite low. Patients with and without subjective need do not differ in personal data but in distress scores.Conclusions: Recommended instruments for distress assessment in psychooncology measure different areas of distress. They do not sufficiently agree in indicating a patient's need for psychooncological treatment. Hence, one should neither compare results of studies using different assessment instruments nor implement a screening without reflecting the used instrument's characteristics compared to the others. The subjective need seems to provide additional information to the assessment. At present, the combination of an assessment instrument and patients' subjective need is seen as a best practice for identifying patients in need of psychooncological treatment. Copyright (C) 2015 John Wiley & Sons, Ltd.

For testing of dynamic light scattering of platelets with ThromboLUX (TLX) in platelet‐rich plasma (PRP) derived from venous whole blood (vWB), anticoagulation is needed. We compared TLX score in PRPs containing citrate, ethylene‐diamine‐tetraacetic‐acid (EDTA), citrate‐phosphate‐dextrose‐adenine (CPDA) or citrate‐theophylline‐adenosine‐dipyridamole. Initial and late TLX scores were measured after 30–120 min or four to six hours, respectively. Compared with citrate, mean differences in initial TLX score were only significant for CPDA. Also, mean differences between initial and late TLX scores were only significant for CPDA. TLX failed to detect EDTA‐induced platelet alterations. The clinical relevance of TLX needs further studies.

The novel allele HLA-B*08:113 identified in two related individuals of Caucasian origin is described.

Abstract Background: Measurement of immature platelets was introduced into routine diagnostics by Sysmex as immature platelet fraction (IPF) some years ago and recently by Abbott as reticulated platelet fraction (rPT). Here, we compare both methods. Methods: We evaluated the precision and agreement of these parameters between Sysmex XE-5000 and Abbott CD-Sapphire in three distinct thrombocytopaenic cohorts: 30 patients with beginning thrombocytopaenia and 64 patients with recovering platelets (PLT) after chemotherapy, 16 patients with immune thrombocytopaenia (ITP) or heparin-induced thrombocytopaenia type 2 (HIT) and 110 additional normal controls. Furthermore, we analysed, how IPF/rPT differed between these thrombocytopaenic cohorts and controls. Results: Both analysers demonstrated acceptable overall precision (repeatability) of IPF/rPT with lower precision at low PLT counts. IPF/rPT artificially increased during storage of blood samples overnight. Inter-instrument comparison showed a moderate correlation (Pearson r²=0.38) and a systematic bias of 1.04 towards higher IPF-values with the XE-5000. IPF/rPT was highest in recovering thrombopoesis after chemotherapy and moderately increased in ITP/HIT. The normal range deduced from control samples was much narrower with CD-Sapphire (1.0%–3.8%, established here for the first time) in comparison to XE-5000 (0.8%–7.9%) leading to a smaller overlap of samples with increased PLT turnover and normal controls. Conclusions: IPF and rPT both give useful information on PLT turnover, although the two analysers only show a moderate inter-instrument correlation and have different reference ranges. A better separation of patient groups with high PLT turnover like ITP/HIT from normal controls is obtained by CD-Sapphire.

Background and ObjectivesPlatelet (PLT) aggregates can occur during or after PLT component processing. However, very few reports investigating the phenomenon and its clinical significance have been published. In this review, currently available information about aggregates in PLT products is summarized and possible causal factors as well as preventive strategies are discussed.Materials and MethodsA review of the MEDLINE (R) database for relevant publications from 1960 to May 2013 was conducted.ResultsIt is well known that PLT aggregates may occur during or after the PLT product preparation process. These aggregates normally dissipate with rest and agitation. However, in some rare cases, the aggregates do not dissipate within 24h and can persist up to the end of storage. Exposure to low temperature, low pH, short resting period after collection, different collection systems, presence of bubbles or foam inside the PLT bag, PLT-container interactions, proper product mixing and donor-dependent variables may have an impact on the formation of PLT aggregates. Although publications are rare, the presence of small numbers of PLT aggregates appears to have only limited impact on PLT in vitro quality. Furthermore, data on the clinical impact of PLT aggregates are lacking.ConclusionDespite the fact that PLT aggregates occur in PLT products, published data on this topic remain scant. Considering the concern of clinicians about this phenomenon, more studies are needed which should focus on the possible clinical impact of such aggregates and precautions to avoid PLT aggregate formation in PLT products.

BACKGROUND:Platelet counts (PCs) <100,000/µl are considered as a contraindication for intravenous thrombolysis (IVT). While US guidelines recommend IVT initiation before the availability of clotting tests, the guidelines of the European Stroke Organization give no such practical advice. We aimed to assess the incidence of thrombocytopenia in IVT patients, outcome after thrombolysis in affected patients and the time gained by initiating treatment prior to availability of PC results. METHODS:All patients with thrombocytopenia were identified in our prospectively acquired thrombolysis database. Baseline demographic data, intracerebral hemorrhage rates as well as functional outcome were assessed. The median time between initiation of thrombolysis and availability of PCs was calculated. RESULTS:Of 625 IVT patients, 3 (0.5%) had thrombocytopenia at stroke onset. None of them developed intracerebral hemorrhage (ICH) or died during the follow-up. Waiting for PCs would have delayed treatment in 72.4% of the patients, with a median hypothetical delay of 22 min (interquartile range: 11-41 min). CONCLUSIONS:To date, there are no sufficient data to evaluate the ICH risk in thrombocytopenic patients. However, thrombocytopenia is rare in IVT patients. Thus, generally waiting for PC results prior to initiation of IVT is not warranted. Avoiding this significant delay yields shorter door-to-needle times and potentially more effective treatment.

The novel allele HLA‐DQB1*02:27 identified in two related individuals of Caucasian origin is described.