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Caregivers play an important role in the in-home care of community dwelling older adults living with Alzheimer's disease or related dementias (ADRD); however, many of these caregivers lack training in caring for this vulnerable population. In 2015, we developed and implemented an interactive, community-based, knowledge and skills-based training program for In-Home Supportive Services (IHSS) caregivers. This report shares the results of a process evaluation of this training program as it evolved over the course of three training sessions in Riverside County, California. Our iterative evaluation process reveals the unique needs of training and assessing a population of demographically diverse adult learners and provides guidance for those planning to implement similar training in underserved communities. Factors such as reliance on self-reported abilities, language readability level, and test anxiety may have confounded attempts to capture learner feedback and actual knowledge gains from our caregiver training program.

As many as 50% of people satisfying diagnostic criteria for dementia are undiagnosed. A team-based training program for dementia screening and management was developed targeting four professions (medicine, nursing, pharmacy, social work) whose scope of practice involves dementia care. An interprofessional group of 10 faculty members was trained to facilitate four interactive competency stations on dementia screening, differential diagnoses, dementia management and team care planning, and screening for and managing caregiver stress. Registrants were organized into teams of five members, with at least one member of each profession per team. The teams rotated through all stations, completing assigned tasks through interprofessional collaboration. A total of 117 professionals (51 physicians, 11 nurses, 20 pharmacists, 24 social workers, 11 others) successfully completed the program. Change scores showed significant improvements in overall competence in dementia assessment and intervention (very low = 1; very high = 5; average change 1.12, P < .001), awareness of importance of dementia screening (average change 0.85, P < .001), and confidence in managing medication (average change 0.86, P < .001). Eighty-seven participants (82.9%) reported feeling confident or very confident using the dementia toolkit at their home institution. In a survey administered 3 months after the session, 48 respondents reported that they had changed their approach to administering the Mini-Cog test (78%), differential diagnosis (49%), assessment of caregiver stress (74%), and accessing community support and services (69%). In conclusion, team-based interprofessional competency training is a team teaching model that can be used to enhance competency in dementia screening and management in medical, nursing, pharmacy, and social work practitioners., (© 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.)

Sometimes duplications of the digestive tract are diagnosed not before adulthood. Single cases of malignant tumours in combination with duplications have been described previously. The poor incidence of this entity is documented by less than 20 reports in the last 107 years. There are so far no reports concerning the development of carcinomas within tubulous duplications of the oesophagus. The case of an adult patient having oesophageal duplication with an adenocarcinoma is reported.

The first successfully operated newborn with esophageal atresia dates back more than 55 years. During this period the concept of the unity of structure and function for surgical treated malformations has been retained. Primary anastomosis offers the best prerequisites. Main life threatening complications are leakage of the anastomosis, anastomotic strictures and gastroesophageal reflux. Avoiding vital complications the aim of undisturbed function can be achieved by appropriate surgical methods. The report describes own experiences over the past 20 years.

From 1970 to 1978 22 children with Hodgkin's lymphomas at the age of 4-15 years were treated at the university children's hospital of Jena. There were 16 patients with the first appearance of the disease and 6 with relapses. The stage classification was carried out after the Ann-Arbor-classification. A "staging" operation with laparotomy and splenectomy was performed in 17 children. The histological material was classified after the Rye-modification of the Lukes-Butler-classification. The clinical staging showed 8 patients in stage I, 7 in stage II, 6 in stage III and one child was in stage IV. The therapy consisted of a telecobalt irradiation extended field irradiation, total nodular and local irradiation) with a focal dose of 4500 rad and a chemotherapy (6 cycles COPP). The life-table-analysis for those patients who were primarily treated in Jena showed a complete five-year-remission rate of 92 per cent. The five-year-survival-rate for all patients (with the first appearance of the disease and with relapses) amounts to 77 per cent. After splenectomy we observed two overwhelmingly progressing aetiologically not clear infections and a pneumococcal meningitis.

The inquiries and evidences demonstrated deal with the consequences of the varicocele disease which had remained unattended in childhood. They are based on representative collective statistics and examinations of the own patients. The parameters density of spermatozoa, motility of spermatozoa, paternity, volume of the testes and histomorphology of the testes refer to the diminution of the fertility beyond adolescence. Operatively treated children have a more favourable prognosis of fertility.

Patients with lung resections due to bronchial carcinoma have a much higher early death rate than patients with lung resections because of pulmonary tuberculosis. Functional failure of the cardiorespiratory system and right heart insufficiency are considered to be the main reasons for this difference. Intracardial pressure values were compared between 530 patients with bronchial carcinoma and 200 patients with pulmonary tuberculosis revealing significantly higher pressure values in the right heart and pulmonary artery for patients with bronchial carcinoma. Predisposing factors of the aged people are fundamental in this respect.

During the 50 year period from 1917 to 1966, 210078 patients were treated in the Surgical Clinic of the University of Jena. Autopsies were carried out on 10083 of the patients which had dies in the Clinic. The average incidence rate of lung embolism was 0.44%, the range of values lying between 0.04% (1917) and 1.02% (1965). In periods of famine or distress, lung embolism reached its lowest point, whereas in periods of relative prosperity a high peak was reached. On the whole, the incidence of pulmonary embolism seem to be the increased age of the patients population and the higher frequency of associated heart and circulatory diseases, obesity, and accidents, as well as the extended indications for surgery in the aged.

Intratubular bodies are not rarely to be found in testicles of children. They are 5 times more freqlently noticed scrotal ones. These storages frequently cause a swelling of the tubuli seminiferi, which are thatswhy called as Ringtubuli. With the help of the fluorescence - and polarisation microscopy and the laser microspectrochemical analysis examinations of the delicate tissue tock place. Intratubular bodies predominant consist of protein and they have an amorphous fine structure.

The kind of the fixation method of bioptic preparations of the testicles has a decisive influence on the morphometrically determinable average diameter of the seminiferous tubules. Under the same conditions experiments 207 preparations of the parenchyma of the testicles of rats were fixed in Bouin's and Carnoy's solution as well as in 10% formalin solution. The measuring values of the diameter of the tubules of the preparations fixed in Bouin's solution were largest. Therefore the authors recommend to perform the fixation of the bioptic preparations of the testicles in Bouin's solution. Thus standardized experimental conditions and possibilities of the comparison of morphometric findings may be got.

The early death rate after lung-resections is caused mainly by right heart failure. The level of pulmonary blood pressure plays a decisive role in this respect. In patients with surgical lung diseases the blood pressure is significantly higher in several parts of lung circulation than in healthy persons. The early death rate after operation was found to be increased in patients with a higher level of preoperative pulmonary artery pressure.

On 89 regularly descended, autoptically obtained testicles, the following morphometric investigations were performed: Calculations of the volums, the mean diameter of the tubuli seminiferi, the total lenght of the tubuli, the mean content of spermatogonia per cross section of one tubulus seminiferus, and the total number of spermatogonia. The testicles evaluated have been obtained from children at the age of one day to fourteen years. The calculation of normal values of quantitatively assessed testicle structures are of fundamental importance for the estimation of the morphological significance of congenitally dystopic testicles.

In nineteen colectomized children operated for Hirschsprung's disease in most instances, size and weight were within normal ranges about six years after surgery. They passed stools, mostly of pulpy consistence, once to ten-times a day, on average four times a day. Eleven children suffered from continence disturbances. Seven developed severe recurrent enteritis. These results as well as those of three children operated according to Martin's technique are compared with those in the literature.

From plains histologic preparations of children's testicles the volume of seminiferous tubules and extratubular tissue were calculated by use of the points counting method. In ectopic testicles, the extratubular part is significantly larger than in normally descended testes. The range of the values measured by this method diminishes the higher the total count of test points is. The 25-points-test-net of VEB Carl Zeiss Jena in particular met all requirements for quantitative examinations of the morphology of testicles.

In the German Democratic Republic a well balanced network of paediatric surgical departments is serving the people. With the help of these specialised institutions the mortality rate of infants and children suffering from surgical diseases could be lowered decisively.

The average diameter of the seminiferous tubules is to be regarded as a criterion for the estimation of the morphological value of testicles. By means of 89 autoptically got preparations of regularly descended testicles the breadth-growth of the tubules depending on age in children was judged. Of 55 untreated congenital dystopic testicles morphometric determinations of the diameters of the seminiferous tubules were performed. At the same time 79 unilaterally and 78 bilaterally operatively dislocated, congenital dystopic testicles and 78 contralateral eutopic gonades were evaluated. The average diameter of the tubule of untreated dystopic testicles is significantly (p less than 0.001) smaller than the diameter of the orthotopic gonades corresponding to age. The average diameter of the tubule of operatively dislocated congenital dystopic testicles is, however, larger than the diameter of the untreated gonades corresponding to age. The earlier the treatment of congenital dystopic testicles is performed the larger are the chances of a development of the tubules corresponding to age.

The method of defecography first described by Burhenne proved to be best suited in systematic examination to detect the different types of impaired evacuation in the area of the sphincters. Pre-and postoperative results of 116 examinations in 86 children are presented.