University of Cologne

About: University of Cologne is a education organization based out in Cologne, Germany. It is known for research contribution in the topics: Population & Transplantation. The organization has 32050 authors who have published 66350 publications receiving 2210092 citations. The organization is also known as: Universität zu Köln & Universitatis Coloniensis.

Validation of World Health Organization Guidelines for cancer pain relief: a 10-year prospective study

Abstract: This paper reports on the experience gained using World Health Organization Guidelines for cancer pain relief over a 10-year period in an anaesthesiology-based pain service associated with a palliative care programme. The course of treatment of 2118 patients was assessed prospectively over a period of 140,478 treatment days. Non-opioid analgesics (WHO step I) were used on 11%, weak opioids (WHO step II) on 31% and strong opioids (WHO step III) on 49% of treatment days. Administration was via the enteral route on 82% and parenterally on 9% of treatment days. On the remaining days, either spinally applied opioids (2%) or other treatments (6%) were utilised. Fifty-six percent of the patients were treated with morphine. Morphine dose escalation was observed in about one-half of the patients being cared for until death, whereas the other half had stable or decreasing doses over the course of treatment. Co-analgesics were administered on 37% of days, most often antidepressants (15%), anticonvulsants (13%) and corticosteroids (13%). Adjuvants to treat symptoms other than pain were prescribed on 79% of days, most commonly laxatives (42%), histamine-2-receptor antagonists (39%) and antiemetics (35%). In addition, palliative antineoplastic treatment was performed in 42%, nerve blocks in 8%, physiotherapy in 5%, psychotherapy in 3% and TENS in 3% of patients. A highly significant pain reduction was achieved within the 1st week of treatment (P < 0.001). Over the whole treatment period, good pain relief was reported in 76%, satisfactory efficacy in 12% and inadequate efficacy in 12% of patients. In the final days of life, 84% rated their pain as moderate or less, while 10% were unable to give a rating. Analgesics remained constantly effective in all 3 steps of the WHO ladder. Other clinical symptoms were likewise significantly reduced at 1 week after initial assessment, with the exception of neuropsychiatric symptoms. During the course of treatment, the latter were the major symptoms on 23% of days, followed by nausea (23%), constipation (23%) and anorexia (20%). Our results emphasise once again the marked efficacy and low rate of complications associated with oral and parenteral analgesic therapy as the mainstay of pain treatment in the palliative care of patients with advanced cancer. Wide dissemination of WHO guidelines among doctors and healthcare workers is thus necessary to effect a clear improvement in the treatment of the many patients suffering from cancer pain in the clinical and home setting.

Diagnosing Schizophrenia in the Initial Prodromal Phase

Abstract: Background In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively Methods The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991 They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia Results During a mean follow-up period of 96 years, 79 (494%) of the 160 patients had transited to schizophrenia The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 098; false-negative predictions: 13%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 059; false-positive predictions: 20%) Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 085-091; false-positive predictions: 19%-75%) Conclusions The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy

Structural Coherency of Graphene on Ir(111)

Abstract: Low-pressure chemical vapor deposition allows one to grow high structural quality monolayer graphene on Ir(111). Using scanning tunneling microscopy, we show that graphene prepared this way exhibits remarkably large-scale continuity of its carbon rows over terraces and step edges. The graphene layer contains only a very low density of defects. These are zero-dimensional defects, edge dislocation cores consisting of heptagon−pentagon pairs of carbon atom rings, which we relate to small-angle in-plane tilt boundaries in the graphene. We quantitatively examined the bending of graphene across Ir step edges. The corresponding radius of curvature compares to typical radii of thin single-wall carbon nanotubes.