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Bad Essen, Germany

Fuhrer D.,Universitatsklinikum Essen AoR
LaboratoriumsMedizin | Year: 2016

This review summarizes recent studies and evidence-based recommendations on management of thyroid disorders, including Graves' disease and Graves' orbitopathy, laboratory and clinical issues on hypothyroidism and its treatment, risk assessment of thyroid nodules and novel concepts for risk adapted management of thyroid cancer. © 2016 by De Gruyter 2016.

NK cells represent the cells of the immune system most effective for eradication of infected or neoplastic cells. Regulatory T cells and the two main subgroups thereof-the naturally occurring nTregs and the tumor-associated induced Tregs (iTregs)-play an important role in the antitumor immune response in cancer patients. The current study explores the intercellular interactions of these groups of cells in tumor patients, particularly in head and neck cancer. Critical interactions between these cells and the cancer cells could be observed in extensive experimental analyses. Firstly, we generated tumor-associated iTregs in a specific human culture. Subsequently, various phenotypic and functional relationships between these cells, nTregs, NK cells and tumor cells were analyzed in an autologous system. Although the activity of naive NK cells was enhanced by iTregs in the presence of tumor cells, the cytotoxic function of NK cells activated by interleukin-2 was markedly inhibited by iTregs and nTregs. Our group was able to document new insights into the complex regulation of human NK cells and regulatory T cells in the tumor microenvironment. These new insights may be of relevance for an improved understanding of the antitumor immune response and the development of immunotherapeutic strategies. © 2014 Springer-Verlag Berlin Heidelberg.

Andreas Grüntzig can be regarded as the pioneer of modern cardiology. Based on the previous experiences of Charles Dotter in Portland, Oregon, and after many years of preparation as a young 38-year-old physician and consultant he carried out the first percutaneous transluminal coronary angioplasty (PTCA) in a 38-year-old patient in Zurich in 1977, supported by the cardiac surgeons A. Senning and M. Turina. Despite high ranking publications and early preparedness to share his experiences the development of PTCA stagnated and was met with great scepticism. The technique was new, technically difficult and aimed at aortocoronary bypass surgery, which was itself still in its infancy 10 years after the introduction in Cleveland in 1968. Even after several years only two patients per week were admitted for treatment in Zurich. In a similar way the young cardiac surgeon H.R. Andersen was a pioneer in Denmark whose ideas and own experiments with a balloon catheter-assisted aortic valve implantation were not initially taken up by the leading companies of the time and publication of the data suffered lengthy delays. It took 10 years before Prof. A. Cribier in Rouen followed up his ideas and carried out the first valve implantation again in pioneer work after many years of preparation in 2002. Again, the new method for treatment of very old and high risk patients needed many years before it was accepted. The breakthrough only became possible when this new technique began to be used in cardiac surgery after the introduction of hybrid cardiac catheter operating rooms. Despite evidence-based studies innovative methods are not subject to the same criteria throughout Europe with respect to the timely introduction of innovative and validated procedures also in consideration of reimbursement and this has become an important initiative of the European Society of Cardiology (ESC). © 2016, Springer Medizin Verlag.

Popp W.,Universitatsklinikum Essen AoR
Public Health Forum | Year: 2014

Nosocomial infections (NI) are dependent on risk factors related to the patient himself and to further conditions during his treatment. Based on different data 30,000 death result from 1.3 Mio NI which ca be calculated for Germany. NI are both one of the greatest problems for health care policy and for the society as a whole.

Objective: Developments in radiation oncology in recent years have highlighted the increasing deployment of personnel resources for tasks not directly related to patients. These tasks include patient-related activities such as treatment planning, reviewing files, and administrative duties (e.g., invoicing for services, documentation). The aim of the present study, part of the QUIRO project of the German Society of Radiation Oncology (DEGRO), was to describe, on the basis of valid data, the deployment of personnel resources in radiation oncology centers for “overhead” tasks.Methods: Questionnaires were used to analyze the percentages of time needed for various tasks. The target group comprised physicians, medical physics experts (MPE), and medical technical radiology assistants (MTRA). A total of 760 personnel from 65 radio-oncology centers in the German inpatient and outpatient sector participated (32 % physicians, 23 % MPE, and 45 % MTRA).Results: High percentages of overhead tasks during working time were measured for each of the three personnel groups considered (physicians, MPE, and MTRA). Patient-related efficiency, i.e., the percentage of working time associated directly or indirectly with the patient, was highest among MTRA and lowest among MPE. Particular features could be seen in the activity profiles of personnel in university clinics. Duties in the areas of research and teaching resulted in a greater percentage of overhead tasks for physicians and MPE. Irrespective of function (physician, MPE, or MTRA), a managerial role resulted in lower patient-related efficiency, as well as a narrower time budget for direct patient care compared with non-managerial employees.Conclusion: Using the data gathered, it was possible to systematically investigate the time required for overhead tasks in radio-oncological centers. Overall, relatively high time requirements for a variety of overhead tasks were measured. These time requirements, generated for example by administrative duties or research and teaching, are currently not taken into adequate consideration in terms of remuneration or personnel capacity planning. © 2014, Springer-Verlag Berlin Heidelberg.

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