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The purpose of this article was to describe the next-of-kin's perspective of the end-of-life (EOL) experiences associated with the death of a family member or close friend. The quality of EOL care from the next-of-kin's perspective given to their loved one needs further study in the context of a community setting focus. A secondary analysis of data from a survey of a random sample of dying experiences in the community setting included qualitative descriptive analysis of open-ended survey data and content analysis used to count the number of positive, negative, mixed, and not applicable responses. Qualitative content analysis of 186 next-of-kin responses revealed two themes: (1) communication and (2) family values and preferences including three subthemes of having a supportive environment to secure a peaceful death with dignity and respect, the desire to be present at the time of death, and attending to the needs and wishes of the dying individual and family. The need for palliative care services in institutionalized settings, continuity of provider care (physician and nurse), family presence, and support for caregiver and financial concerns with hospice services was identified. Communication remains an essential component in all aspects of EOL care with further examination involving the loved one's perspectives. [ABSTRACT FROM AUTHOR]

The author reflects on the successful cooperation of biometry, epidemiology and medical informatics. The educational model of combing epidemiology, medical biometrics and medical informatics as one discipline in the physician's curriculum or in the curriculum of medical informatics is not mentioned in papers about challenges for medical informatics as an academic discipline. The three methodologically oriented disciplines cooperate in a cross-sectional manner with all clinical disciplines and the whole field of health care, research and teaching.

Objectives: To present an overview of early European and American work on Electronic Medical Records and patient information.Method: The invited lectures of "pioneers of electronic patient information" given at the farewell symposium of Wolfgang Giere in Frankfurt, Germany, are summarized and discussed.Results: The origin of medical record writing goes back to Hippocrates and over many centuries this important medical duty was regarded as an annoying, laborious and error-prone task. First steps towards a better medical record started in 1936 with punch cards. In the 1960s the minimum basic data set, a unique patient ID was introduced and even for outpatients first computerized medical record systems were developed applying some important standards and well accepted data structures. Nowadays multimedia are included in patient record systems, highly specialized subsystems e.g. for radiology or cardiology are available, and semantic and statistic mining techniques as well as medical classifications and standardized terminologies support evaluation. All these methods should primarily improve the quality of care, reduce errors, improve communication between multiple specialists, reduce wait times for patients and improve efficiency.Conclusions: Over decades it became obvious that the structure of a medical record notably for coded data but also for narrative text and pictures must be carefully modelled. Well maintained standardized health terminologies and medical classifications are important issues for a user-friendly electronic medical record, which bring benefits for clinicians and patients. [ABSTRACT FROM AUTHOR]

Approximate equations for radiative heat transfer equations coupled to an equation for the temperature are stated and a comparative numerical study of the different approximations is given. The approximation methods considered here range from moment methods to simplified PN-approximations. Numerical experiments and comparisons in different space dimensions and for various physical situations are presented. [ABSTRACT FROM AUTHOR]

The Oral and Maxillofacial Surgery (OMF) is one of the four main subjects in the clinical curriculum of dental medicine in Germany. Despite of the large collegiate demand there are only few e-learning offers in this subject now. Here, we present the development of an E-Learning facility in the subject of OMF, that combines systematical knowledge with case based clinical knowledge. A high disposition to work with E-learning was asserted in the student body with a structured questionary in a user and demand analysis. As important issues in E-learning students mentioned: search functionality, learning questions, links between systematical textbook knowledge and clinical case knowledge, embedding multimedial sources and the clarity of navigation. An established OMF textbook in combination with clinical cases are presented in an integrated web platform to achieve these demands. Links between XML case representation and systematical knowledge are navigable and searchable. Based on the representation that has been developed on the structure of medical cases as so far 15 case were implemented. Compared to classical attempts of case-based learning the presented effort is relatively “lightweight”, however, associated with reduced development effort. Central aspects of case based learning are accomplished without abandoning the systematic textbook knowledge. The XML structures are standardized (DocBook) or generic so that utilization is possible in variable contexts.

[english] At the project location within the University of Freiburg, it has been possible to develop an interdisciplinary, case-based e-learning system in the area of neuro-oncology using OncoCase. In addition, an established e-learning platform was adapted and implemented using Campus .OncoCase is well received and evaluated by students as a blended learning option. [german] Am Projektstandort Universitätsklinikum Freiburg ist es gelungen, mit ein interdisziplinäres fallbasiertes E-Learning System im Bereich der Neuro-Onkologie aufzubauen. Dazu wurde mit eine bewährte E-Learning Plattform angepasst und genutzt. Als blended learning Angebot wird von den Studenten gut angenommen und bewertet.

In the Approbationsordnung für Ärzte (German regulation for the Curriculum in Medicine) of 27th June, 2002 the disciplines Epidemiology, Medical Biometry and Medical Informatics are combined in one obligatory cross-sectional subject of the second part of the medical exam. In addition, it is possible to study topics from these disciplines in more detail on a voluntary basis. The aim of teaching this cross-sectional subject is to qualify the students to assess their own actions critically, to apply recommendations with care, and to learn to use tools like systematic documentation and modern information technology.For the mentioned disciplines a catalogue has been developed which is subdivided in three parts. In the first part methods are described which are needed to support medical decisions. The second part refers to support of medical supply and quality management, whereas the third part deals with the basic elements of Public Health and Health Economics, with respect to causation of diseases and prevention.

The article reports that in the spring of 2003, Wolfgang Giere, the director of the Department of Medical Informatics at the J. W. Goethe University in Frankfurt, Germany, retired after more than 35 years of work in the area of computerized medical documentation and communication, i.e. Medical Informatics. Wolfgang Giere was born in 1936 in Konigsberg, East Prussia, now Russia. After attending a secondary school specializing in the humanities, he studied medicine in Tubingen, Munich, Montpellier, and Marseille. As a medical doctor with experience in data processing, in 1968 he built up the first electronic patient record at a hospital in Duisburg. He then became the chief of the computer center of the famous German Clinic for Diagnostics in Wiesbaden, and from 1976 to 2003 he worked as a full Professor of Medical Informatics at the University Hospital in Frankfurt. For decades, Wolfgang Giere has been a strong influence on Medical Informatics in Germany with his ideas, projects, and his excellent international contacts. On the occasion of Wolfgang's retirement, an international farewell symposium took place at Frankfurt University on May 16, 2003.

Early characterization of the immunostimulatory potential of therapeutic antisense oligonucleotides (ASOs) is crucial. At present, little is known about the toll-like receptor 9 (TLR9)-mediated immunostimulatory potential of third-generation locked nucleic acid (LNA)-modified ASOs. In this study, we have systematically investigated the TLR9-activating potential of LNA-modified oligonucleotides using different mouse and human cell culture systems. Although it has been reported that LNA modifications as well as cytosine methylation of 5'-cytosine-phosphate-guanine-3' (CpG) motifs can reduce TLR9 stimulation by phosphorothioate (PTO)-modified oligonucleotides, we identified CpG-containing LNA gapmers with substantial TLR9-stimulatory activity. We further identified immunostimulatory LNA gapmers without CpG motifs. Unexpectedly, methylation of cytosines only within the CpG motif did not necessarily reduce but could even increase TLR9 activation. In contrast, systematic methylation of all cytosines reduced or even abrogated TLR9 activation in most cases. Context dependently, the introduction of LNA-modifications into the flanks could either increase or decrease TLR9 stimulation. Overall, our results indicate that TLR9-dependent immunostimulatory potential is an individual feature of an oligonucleotide and needs to be investigated on a case-by-case basis.

Background: The Spike protein mutation severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to decreased protective effect of various vaccines and mAbs, suggesting that blocking SARS-CoV-2 infection by targeting host factors would make the therapy more resilient against virus mutations. Angiotensin-converting enzyme 2 (ACE2) is the host receptor of SARS-CoV-2 and its variants, as well as many other coronaviruses. Downregulation of ACE2 expression in the respiratory tract may prevent viral infection. Antisense oligonucleotides (ASOs) can be rationally designed on the basis of sequence data, require no delivery system, and can be administered locally., Objective: We sought to design ASOs that can block SARS-CoV-2 by downregulating ACE2 in human airway., Methods: ACE2-targeting ASOs were designed using a bioinformatic method and screened in cell lines. Human primary nasal epithelial cells cultured at the air-liquid interface and humanized ACE2 mice were used to detect the ACE2 reduction levels and the safety of ASOs. ASO-pretreated nasal epithelial cells and mice were infected and then used to detect the viral infection levels., Results: ASOs reduced ACE2 expression on mRNA and protein level in cell lines and in human nasal epithelial cells. Furthermore, they efficiently suppressed virus replication of 3 different SARS-CoV-2 variants in human nasal epithelial cells. In vivo, ASOs also downregulated human ACE2 in humanized ACE2 mice and thereby reduced viral load, histopathologic changes in lungs, and increased survival of mice., Conclusions: ACE2-targeting ASOs can effectively block SARS-CoV-2 infection. Our study provides a new approach for blocking SARS-CoV-2 and other ACE2-targeting virus in high-risk populations., Competing Interests: Disclosure statement This study was supported by Guangdong Research Program of Key Fields grant, National Natural Science Foundation of China grants, Natural Science Foundation of Guangdong Province grants, and Guangzhou Science and Technology Project of China grant. Disclosure of potential conflict of interest: The authors have filed patent applications for human angiotensin-converting enzyme 2–targeting antisense oligonucleotides and their activities in inhibiting severe acute respiratory syndrome coronavirus 2 infection., (Copyright © 2024. Published by Elsevier Inc.)

Antisense oligonucleotides (ASOs) are a novel therapeutic strategy that targets a specific gene and suppresses its expression. The cryopyrin-associated periodic syndromes (CAPS) are a spectrum of autoinflammatory diseases characterized by systemic and tissue inflammation that is caused by heterozygous gain-of-function mutations in the nucleotide-binding and oligomerization domain-like receptor (NLR) family pyrin domain containing 3 (NLRP3) gene. The aim of this study was to investigate the efficacy of an Nlrp3-specific ASO treatment in CAPS. An Nlrp3-specific ASO was designed and tested in murine cell lines and bone marrow-derived macrophages (BMDMs) from wild-type and CAPS mouse models. Nlrp3 knock-in mice were treated in vivo with Nlrp3-specific ASO, survival was monitored, and expression of organ-specific Nlrp3 and IL-1β was measured. Nlrp3-specific ASO treatment of murine cell lines and BMDMs showed a significant downregulation of Nlrp3 and mature IL-1β protein expression. Ex vivo treatment of Nlrp3 mutant mouse-derived BMDMs with Nlrp3-specific ASO demonstrated significantly reduced IL-1β release. In vivo, Nlrp3-specific ASO treatment of Nlrp3 mutant mice prolonged survival, reduced systemic inflammation, and decreased tissue-specific expression of Nlrp3 and mature IL-1β protein. The results of this study demonstrate that Nlrp3-specific ASO treatment downregulates Nlrp3 expression and IL-1β release in CAPS models, suggesting ASO therapy as a potential treatment of CAPS and other NLRP3-mediated diseases., (Copyright © 2023 by The American Association of Immunologists, Inc.)