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Steinau an der Straße, Germany

Background: Although 80 % of adolescent and young adult (AYA) patients survive beyond 5 years from the cancer diagnosis, the majority of patients are faced with specific forms of psychosocial stress and distress; however, they are distinguished from other cancer patient groups because of several developmental challenges between early adolescence and young adulthood. In accordance with research-based knowledge, the purpose of the present review is to derive psycho-oncological recommendations for an AYA-specific cancer care. Results: Clinical requirements of an integrated AYA cancer care involve: (1) clearly decreased mental health and quality of life with an impact on awareness of the problems, inclination to regression, coping with illness and cancer-related stress in everyday life, (2) often disregarded AYA-specific supportive care needs, e.g. information sharing and communication needs with respect to the need for information to reduce anxiety and fear, informed decision-making and assistance in skill acquisitions and (3) increased treatment non-adherence and developing a sustainable therapeutic patient-oncologist alliance. Psychological and behavioral adaptation as the primary aims of cancer situations are contrasted by the development of a strong identity and social bonding as primary aims of AYA stages of psychosocial development. This scenario is accentuated by tension and is therefore a challenge for AYA cancer care providers. Discussion: Existing healthcare structures and approaches are insufficient for AYA cancer patients. Current efforts of AYA networks aim at reducing cancer treatment-related distress and late sequelae. If regional AYA cancer care is to be initiated, an assessment of the psychosocial needs of AYA patients should be incorporated into the care planning and appropriate training programs in AYA oncology need to be worked out. © 2015, Springer-Verlag Berlin Heidelberg.

Beck N.,Universitatsklinikum Magdeburg Aor | Meyer F.,Universitatklinikum Magdeburg Aor Deutschland
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2016

Background: Forensic medicine finds more and more resonance due to requests and queries from clinicians and acts as a mediator between the individual medical disciplines, in particular with regard to legal issues, and as an interface between the fields of medicine, police and judiciary. The aim of this short narrative overview is to make surgeons aware of the forensic aspects of their work, which is usually focused on clinical and curative aspects. Crucial points: Traditionally, the basic work in forensic medicine comprises sudden and unexpected deaths, for which it is important to definitely clarify the mode of death based on the detected cause of death. In addition to violent and unnatural deaths, there are sudden natural deaths, which are natural, but also unsolved. Clinical forensic medicine basically concentrates on the examination of victims of violence, which may comprise various types of bodily harm including sexual crime, child maltreatment and traffic accidents. The investigational results (autopsy findings, injury patterns, results from the investigation of traces) need to be presented and interpreted in public procedures at court by forensic medicine specialists, who act as experts answering questions while retaining a neutral position. Conclusion: Specialists in forensic medicine should not only be consulted for issues related to the inspection of corpses and to issue a death certification. Much rather, they should also be consulted as specialised partners of surgeons and other clinicians, e.g. for the documentation of specific findings and the description of injury patterns in injured persons who are still alive. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Hellmann W.,Institute For Kooperative Kundenorientierung Hanover | Meyer F.,Universitatsklinikum Magdeburg Aor
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2016

Background: Surgeons, more than other specialists, are required to combine high medical expertise with management competence. This is due to changing environments, new demands with respect to quality, the ongoing discussion on increased performance in the context of questionable target agreements, an increasing tendency of university hospitals and other departments and clinics to recruit leading personnel in medicine with management competence, but also to the understanding of oneʼs own role and surgeonsʼ distinguished public reputation. Aim: This narrative review describes the changing environments for surgeons in leading positions in hospitals and provides an overview on the practical use of management skills in surgery. In addition, it advises on how to acquire management competence and presents an educational concept appropriate for surgeons in leading positions. Key points: 1. The management of new challenges in the healthcare system – also in clinical surgery – requires management skills, which are indispensable for a surgeon in a leading position. 2. Management skills in surgery comprise aspects such as communication ability, social competence, cooperation and leadership skills, knowledge on business administration aspects and legal certainty. 3. The necessary knowledge can be acquired in courses leading to a certificate (e.g. “MHM® Medical Hospital Manager”) or by earning a “Master of Business Administration” (MBA). Conclusion: Management competence is essential in leading positions in clinical surgery today. The use of these skills is challenging in daily practice. Successfully applied, management competence not only guarantees comprehensive patient care and leadership of employees, but also provides satisfaction in leading positions of a surgical department. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Peters I.,Managementtraining Ingrid Peters | Meyer F.,Universitatsklinikum Magdeburg Aor
Zentralblatt fur Chirurgie - Zeitschrift fur Allgemeine, Viszeral- und Gefasschirurgie | Year: 2016

Clinical departments are constantly faced with complex and novel tasks, which have to be managed with suitable approaches. This article describes selected aspects of project management in this context. In particular, it concentrates on the advantages and limitations of project management methods that have been established in industrial companies when used in a clinical setting. Also it compares the daily reality in clinical departments and industrial companies and highlights possible associations between surgery and project management. Besides aspects such as project planning, role definitions within projects and their specific casting in clinics, the article also demonstrates key success factors for an effective implementation of projects and a general introduction to project management in clinics. The article combines theoretical approaches with practical experience and thought-provoking impulses. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Background: ERCP and PTCD are considered the gold standard in the interventional treatment of biliary obstruction, in particular, with palliative intention. If ERCP and PTCD are not possible, an alternative drainage procedure such as the EUS-guided cholangiodrainage (EUCD) can be used. Aim/Method: By the mean of a compact review, indication, technique, variants of approach, number of treated patients and therapeutic procedures reported by various authors, success rate, spectrum and management of complications as well as recommendations for an appropriate follow-up-investigation protocol for EUCD based on our own clinical experiences and compared to published data are described. Results: EUCD is an interventionally endoscopic/-sonografic procedure, which is used in case of postoperatively changed anatomy of the upper GI tract (BII gastric resection, PPPHR, Whipple procedure, [sub-]total gastrectomy, Roux-en-Y reconstruction) and, thus, if papilla of Vater (papilla) can not be reached or catheterized or if the patient denies PTCD in subjects with recurrent, advanced or metastasized tumor lesion(s) of the upper abdomen, hepatobiliary system as well as pancreas and associated obstruction of the biliary tree /+ jaundice. Principle: EUS-guided transluminal puncture from the upper GI tract into various extra-/intrahepatic segments of the biliary system, recanalization of the tumor stenosis with stent insertion through the access site or bypassing the tumor (stent-based retro- or antegrade drainage of the biliary tree). Derived from this, there are various approaches and procedures- EUCD i)combined with rendesvouz technique, ii/iii)transhepatically with retro- (permanent hepaticoenterostomy)/antegrade internal drainage, iv)extrahepatically with antegrade drainage (permanent choledocho-enterostomy), which are distinguished according to tumor site, possible direction of translumenal puncture, insertion of a guide wire and final stent placement. Within the spectrum of complications (rate 0-25%), bleeding, perforation, stent dislocation/-migration/-occlusion and slight postinterventional pain are relevant. Currently, approximately 200 cases have been published worldwide; the clinical experience of the reporting institution is based on more than >70interventions. Discussion: With regard to the limited diffusion process, EUCD cannot be considered a standard procedure yet. The advantages comprise low tissue trauma, primary internal drainage and the possible endoscopic re-intervention in case of complications. The high technical challenge in performing EUCD is a disfavourable aspect for broader use in clinical practice. However, the disclosed treatment results demonstrating an acceptable complication rate show that EUCD can be competitively considered to ERCP und PTCD with a great chance for primary success. Conclusion: EUCD is an elegant, not yet fully established, but rather still experimental procedure of interventional endoscopy/EUS, which needs great expertise of the endoscopist in an interdisciplinary centre of visceral medicine as one of the main predictions. In experienced hands, a safe procedure can be provided, for which a systematic follow-up and a multicentre evaluation of periinterventional management are still needed in order to achieve a final assessment of EUCD for guideline approval. © Georg Thieme Verlag KG Stuttgart · New York.

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