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Biomedical subjects

W Otten

Publications and source records attributed to W Otten.

At least 19 recordsLinked to original sources
PubMed2006

How important is the opinion of significant others to cancer patients' adjuvant chemotherapy decision-making?

GOALS: Decisions regarding adjuvant chemotherapy are difficult, since value tradeoffs are involved. Little is known about the importance of the significant others in patients' decision-making regarding adjuvant treatment. We surveyed patients with breast and colorectal cancer about the importance they assigned to the opinions of their significant others and assessed correlates of these importance scores. MATERIALS AND METHODS: One hundred and twenty-three patients rated on a five-point scale how much they cared about the opinion of six significant others. MAIN RESULTS: Most important was the opinion of their treating specialist, followed by that of their partner, children, other family, friends, and colleagues. Women assigned higher scores to the opinion of their children, younger patients to that of their specialist, and patients who were about to undergo chemotherapy to that of their family. Patients with breast cancer and patients without paid employment assigned slightly more importance to the opinion of their partner. CONCLUSIONS: Information on the influence of significant others may help clinicians when involving patients in treatment decision-making and discussing patients' treatment preferences.

Adult↗
PubMed2006

Clinical ethical dilemmas: convergent and divergent views of two scholarly communities.

OBJECTIVE: To survey members of the American Society for Bioethics and Humanities (ASBH; n = 327) and of the Society for Medical Decision Making (SMDM; n = 77) to elicit the similarities and differences in their reasoning about two clinical cases that involved ethical dilemmas. CASES: Case 1 was that of a patient refusing treatment that a surgeon thought would be beneficial. Case 2 dealt with end-of-life care. The argument was whether intensive treatment should be continued of an unconscious patient with multiorgan failure. METHOD: Four questions, with structured multiple alternatives, were asked about each case: identified core problems, needed additional information, appropriate next steps and who the decision maker should be. OBSERVATIONS AND RESULTS: Substantial similarities were noticed between the two groups in identifying the core problems, the information needed and the appropriate next steps. SMDM members gave more weight to outcomes and trade-offs and ASBH members had patient autonomy trump other considerations more strongly. In case 1, more than 60% of ASBH respondents identified the patient alone as the decision maker, whereas members of SMDM were almost evenly divided between having the patient as the solo decision maker or preferring a group of some sort as the decision maker, a significant difference (p<0.02). In case 2, both groups agreed that the question of discontinuing treatment should be discussed with the family and that the family alone should not be the decision maker. CONCLUSION: Despite distinctively different methods of case analysis and little communication between the two professional communities, many similarities were observed in the actual decisions they reached on the two clinical dilemmas.

Aged↗
PubMed2006

[Alternatives for castration of suckling piglets, determination of catecholamines and wound healing after castration of suckling piglets at different points of time].

According to the applicable animal welfare legislation, the surgical castration of pigs is allowed up until the age of 4 weeks, without anaesthesia. According to the european guideline (2001/93/EG) it is only permitted in the first week after birth. The investigation should show, whether the castration of young piglets takes a milder course and to what extent stress reactions occur in different age groups. The healing process of castration wounds in piglets that were castrated at the age of four days progressed more rapidly and with less complications than those piglets that were castrated at 28 days of age. The catecholamine levels in younger piglets rose significantly after the operation, while these levels virtually stayed the same in piglets castrated at 28 days. As alternatives to castration without anaesthesia, several methods are in discussion: (1) Castration under general anaesthesia can only be practiced by a veterinary surgeon. The sole use of Azaperon and Ketamine has insufficient pain sedating effect. Isofluran anaesthesia is apparatively extravagant. (2) CO2-Anaesthesia in piglets leads to high strain. (3) Castration under local anaesthesia must be practiced by a veterinary surgeon. The application and the pain after the castration are not taken into consideration. (4) Jung boar fattening up until the slaughtering weight of 80 kg is not transformable, because of boar taste. (5) The breeding of slaughter pigs with little boar taint is not yet transformable. (6) Sperm sexing is not and will not, in the near future, be mature for practice. (7) Immunocastration is an active immunisation against GnRH. The immunological elimination of GnRH suppresses the development of sex hormones, such as testosterone, as well as the substance responsible for boar taint, Androstenone. To consider is the acceptance of the consumer. The preparation has the same effect in humans as it has in swine. "Self injections" have the same effect in humans as it has in swine. "Self injections" are therefore risky.

Age Factors↗
PubMed2005

Explaining differences in attitude toward adjuvant chemotherapy between experienced and inexperienced breast cancer patients.

PURPOSE: Previous studies have shown that patients who have experienced adjuvant chemotherapy (experienced patients) have a more favorable attitude towards chemotherapy than those who have not (inexperienced patients). However, not much is known about the reasons underlying this difference. According to the Theory of Planned Behavior, the attitude towards a particular behavior (eg, accepting chemotherapy) is based on beliefs about the likelihood of outcomes of the behavior and the evaluations of these outcomes. We used this theory to explore in what way the beliefs of experienced patients differed from those of inexperienced patients. PATIENTS AND METHODS: A cross-sectional survey was undertaken among 719 patients who had been treated for early-stage breast cancer between 1998 and 2003. Patients were asked, first, to indicate the likelihood of six positive and six negative outcomes of undergoing chemotherapy and, second, to give their evaluation of these outcomes. RESULTS: Four hundred forty-six women filled in the questionnaire (response rate, 62%). As hypothesized, experienced patients (ie, patients who had been treated with adjuvant chemotherapy as part of their primary treatment plan) had a more positive attitude towards chemotherapy. Experienced patients provided higher likelihood estimates of treatment advantages, such as life prolongation. In addition, they evaluated the positive outcomes of chemotherapy more favorably. With regard to the negative outcomes of chemotherapy, few differences were observed between treatment groups. CONCLUSION: Experienced patients have more confidence in the positive outcomes of chemotherapy than inexperienced patients. This might be the result of a cognitive mechanism to justify the way in which patients were treated.

Adaptation, Physiological↗
PubMed2004

A system of networks and continuing education for physical therapists in rheumatology: a feasibility study.

PURPOSE: To evaluate the feasibility of regional physical therapy networks including continuing education in rheumatology. The aim of these networks was to improve care provided by primary care physical therapists by improving specific knowledge, technical and communicative skills and the collaboration with rheumatologists. METHODS: In two regions in The Netherlands continuing education (CE) programmes, consisting of a 5-day postgraduate training course followed by bimonthly workshops and teaching practices, were organised simultaneously. Network activities included consultations, newsletters and the development of a communication guideline. Endpoint measures included the participation rate, compliance, quality of the CE programme, teaching practices, knowledge, network activities, communication, number of patients treated and patient satisfaction. RESULTS: Sixty-three physical therapists out of 193 practices (33%) participated in the project. They all completed the education programmes and were formally registered. All evaluations of the education programmes showed positive scores. Knowledge scores increased significantly directly after the training course and at 18 months. A draft guideline on communication between physical therapists and rheumatologists was developed, and 4 newsletters were distributed. A substantial proportion of physical therapists and rheumatologists reported improved communication at 18 months. The mean number of patients treated by physical therapists participating in the networks increased significantly. Patients' satisfaction scores within the networks were significantly higher than those from outside the networks at 18 months. CONCLUSIONS: Setting up a system of networks for continuing education for physical therapists regarding the treatment of patients with rheumatic diseases is feasible. Further research will focus on the effectiveness of the system and its implementation on a larger scale.

Journal Article↗
PubMed2004

The impact of the perception of treatment choice on satisfaction with treatment, experienced chemotherapy burden and current quality of life.

Previous research has shown that involving patients in the decision-making process may improve their quality of life (QoL). Our purposes were to assess: (1) whether early-stage breast cancer patients perceived that they had treatment choice with regard to adjuvant chemotherapy, (2) what reasons patients provide for their perception of having had no choice of treatment and (3) whether the perception of treatment choice is related to satisfaction with the assigned treatment, experienced chemotherapy burden and current QoL. A total of 448 patients, treated between 1998 and 2003, filled in the questionnaire (response rate: 62%). Patients who indicated that they had not perceived a choice regarding chemotherapy could tick off one or more reasons out of 10 reasons, or provide their own reason(s). Quality of life was measured on a Visual Analogue Scale, by means of the EuroQol, and by means of the Hospital Anxiety and Depression Scale. Of the 405 patients who had answered the question on treatment choice, 316 patients (78%) had perceived no choice. The most frequently indicated reason for lack of choice was: "I follow the doctor's advice." We found no differences in the levels of satisfaction with assigned treatment and in how much of a burden they found chemotherapy between patients who perceived a choice of treatment and those who did not. In general, the perception of choice seemed to have no impact on QoL. However, we found an interaction effect, which indicated that the impact of perception of treatment choice on QoL was dependent upon whether the patient had been treated with chemotherapy or not. Within the group of patients who had not been treated with chemotherapy, the perception of having had a choice was related to lower current QoL. In cases when the decision to be treated or not has potential consequences for the chance of survival, patients' QoL may not be improved by the perception of having had a choice of treatment.

Adult↗
PubMed2004

Maternal reproductive hormone levels after repeated ACTH application to pregnant gilts.

Prenatal stress has been seen as a reason for reproductive failures in pig offspring mostly originated or mediated by changed maternal functions. In pregnant gilts, three experiments (EXP I-III) were conducted to characterize the effects of repeated ACTH on maternal cortisol concentrations (EXP I) and on the secretion of maternal reproductive hormones (LH, progesterone, estrone sulfate; EXP II + III). Exogenous ACTH was given six times every alternate day beginning either on day 49 (EXP I + II) or day 28 (EXP III) of pregnancy. As a result of treatment, elevated cortisol levels were observed for more than 6 h (EXP I). Plasma concentrations of LH were at low basal level (0.1-0.2 ng/ml), but showed a pulsatory release pattern both during first and second trimester of pregnancy. The number of LH pulses/6 h (L.S.M. +/- S.E.) of saline treated controls increased with ongoing pregnancy (1.4 +/- 0.1 versus 2.0 +/- 0.2 in EXP III and EXP II, respectively). After ACTH treatment the number of LH pulses did not differ between the two gestational stages (1.3 +/- 0.2 and 1.4 +/- 0.2 in EXP III and EXP II, respectively). However, differences ( P < 0.05) were obtained comparing the LH pulse number of ACTH and saline treated sows during the second trimester of pregnancy. Moreover, areas under the curve (AUC) of each LH pulse and of all LH values over the baseline were significantly reduced by treatment. The levels of progesterone increased (P < 0.05) for 150-170 min after each ACTH application both in EXP II and EXP III. The concentrations of 17alpha-hydroxy-progesterone revealed likewise a significant elevation after each ACTH injection. Throughout EXP III, estrone sulfate concentrations were found to decrease (from 2.8-16.9 ng/ml on day 28 to 0.02-0.04 ng/ml on day 38) but without differences between ACTH-and saline-treated gilts. Further data of EXP II and EXP III, e.g. number of piglets born alive, confirmed the absence of detrimental treatment effects. Thus, repeated ACTH administration with subsequent release of cortisol is able to influence the release pattern of maternal reproductive hormones. However, these findings demonstrate that stress-related effects are dependent on the stage of pregnancy. The detected changes may affect feto-maternal interactions and, as a result, fetal reproductive development.

17-alpha-Hydroxyprogesterone↗
PubMed2004

Inferring the dynamics of a spatial epidemic from time-series data.

Spatial interactions are key determinants in the dynamics of many epidemiological and ecological systems; therefore it is important to use spatio-temporal models to estimate essential parameters. However, spatially-explicit data sets are rarely available; moreover, fitting spatially-explicit models to such data can be technically demanding and computationally intensive. Thus non-spatial models are often used to estimate parameters from temporal data. We introduce a method for fitting models to temporal data in order to estimate parameters which characterise spatial epidemics. The method uses semi-spatial models and pair approximation to take explicit account of spatial clustering of disease without requiring spatial data. The approach is demonstrated for data from experiments with plant populations invaded by a common soilborne fungus, Rhizoctonia solani. Model inferences concerning the number of sources of disease and primary and secondary infections are tested against independent measures from spatio-temporal data. The applicability of the method to a wide range of host-pathogen systems is discussed.

Disease Outbreaks↗
PubMed2004

Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' views.

OBJECTIVES: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy. METHODS: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability. RESULTS: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure. DISCUSSION: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles.

Attitude of Health Personnel↗
PubMed2003

Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment.

Scientific reports suggest that women at risk for familial breast cancer may benefit from prophylactic mastectomy. However, few data are available about how women decide upon this clinical option, and in particular, what role an objective risk assessment plays in this. The purpose of the present study is to assess whether this objective risk information provided in genetic counselling affects the intention for prophylactic mastectomy. Additionally, the (mediating) effects of breast cancer worry and perceived risk are investigated. A total of 241 women completed a questionnaire before and after receiving information about their familial lifetime breast cancer risk in a genetic counselling session. Path analysis showed that the objective risk information had a corrective effect on perceived risk (beta=0.38; P=0.0001), whereas the amount of breast cancer worry was not influenced by the counselling session. The objective risk information did not directly affect the intention for prophylactic mastectomy. The intention was influenced by perceived risk after counselling (beta=0.23; P=0.002), and by the precounselling levels of perceived risk (beta=0.27; P=0.00025) and breast cancer worry (beta=0.32; P=0.0001), that is, higher levels of perceived risk and breast cancer worry imply a stronger intention for prophylactic mastectomy. A personal history of breast cancer did not directly influence the intention for prophylactic mastectomy, but affected women who had undergone a mastectomy as surgical treatment were more positively inclined to have a prophylactic mastectomy than women who had had breast-conserving therapy. The impact of objective risk information on the intention for prophylactic mastectomy is limited and is mediated by perceived risk. Important determinants of the intention for prophylactic mastectomy were precounselling levels of breast cancer worry and perceived risk, suggesting that genetic counselling is only one event in the entire process of decision making. Therefore, interventions aimed at improving decision making on prophylactic mastectomy should explicitly address precounselling factors, such as personal beliefs and the psychological impact of the family medical history.

Adult↗
PubMed2003

Implicit normativity in evidence-based medicine: a plea for integrated empirical ethics research.

This paper challenges the traditional assumption that descriptive and prescriptive sciences are essentially distinct by presenting a study on the implicit normativity of the production and presentation of biomedical scientific facts within evidence-based medicine. This interdisciplinary study serves as an illustration of the potential worth of the concept of implicit normativity for bioethics in general and for integrated empirical ethics research in particular. It demonstrates how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions and values, which prestructure the moral environment of the clinical process of decision-making. As a consequence, the evidence-based decision support did not only support the clinical decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy that information disclosure is a conditional requirement before patient autonomy even starts; patient autonomy is already influenced during the production and presentation of information. These results imply an increased responsibility of those who produce and present evidence-based facts (i.e. scientists in general and physicians in particular). The insights of this study not only involve a different focus on both theory and practice of patient autonomy and informed consent, but they also call for a broader scope of morality than does traditional empirical research in bioethics. The concept of implicit normativity within integrated empirical ethics research calls for strong cooperation between bioethicists and descriptive scientists, i.e., a cooperation that goes beyond the discipline-specific epistemic values and that takes place during all phases of the research process.

Bioethics↗
PubMed2003

Effects of prenatal stress on corticosteroid receptors and monoamine concentrations in limbic areas of suckling piglets (Sus scrofa) at different ages.

The present study was conducted in order to reveal the effects of prenatal stress on the central stress regulation in domestic pigs by measuring changes in corticosteroid receptor binding and monoamine concentrations in different limbic brain regions. Pregnant sows were subjected to a restraint stress for 5 min daily during the last 5 weeks of gestation. Maternal stress resulted in a significantly higher number of glucocorticoid receptors in the hippocampus, but decreased glucocorticoid receptors in the hypothalamus of the offspring at the first postnatal day. No alterations of hippocampal mineralocorticoid receptors were found. There was also no significant effect of prenatal stress on the brain monoamine concentrations. Prenatally stressed piglets showed lower basal plasma cortisol and increased corticosteroid binding globulin concentrations at the third postnatal day indicating decreased free cortisol concentrations after birth. Morbidity and mortality during the suckling period were significantly increased in prenatally stressed litters, as shown by a higher frequency of diseased and died piglets per litter. In conclusion, the results indicate that in pigs restraint stress during late gestation affects the ontogeny of the foetal neuroendocrine feedback system with consequences for the regulation of the hypothalamo-pituitary-adrenal function and the vitality of the offspring.

Adrenocorticotropic Hormone↗
PubMed2002

Effects of prenatal stress on cellular and humoral immune responses in neonatal pigs.

In the present study, we investigated the effects of a daily 5 min restraint stress of pregnant sows in the last five gestational weeks on the development and reactivity of the immune system of the offspring. Maternal stress resulted in significant decreased serum immunoglobulin G (IgG) concentrations in suckling piglets at 1 and 3 days of age. Furthermore, the stress treatment of the sows had an immunosuppressive effect on lymphocyte proliferation in response to the T-cell mitogen concanavalin A (ConA) at postnatal days 1 and 7. A suppressive effect was also found in response to the B-cell mitogens lipopolysaccharid (LPS) at days 1 and 35 and pokeweed mitogen (PWM) at day 1 of life, whereas natural killer (NK) cell cytotoxicity was not altered by prenatal stress. The relative thymus weights were significantly reduced in prenatally stressed piglets on the first and 35th day of life and the morbidity and mortality during the suckling period were significantly increased in prenatally stressed litters, as shown by a higher frequency of diseased and died piglets per litter. In addition, the ConA-, LPS- and PWM-stimulated lymphocyte proliferation at the age of 7, 21 and 35 days, and the NK cell cytotoxicity at the age of 21 and 35 days decreased in prenatally stressed and in control piglets 1h after a corticotropin (ACTH) injection. However, the cellular immunity was always higher in the control piglets which might be a result of the weaker stress hormone reactivity in prenatally stressed animals. In conclusion, the results provide first experimental evidence that prenatal maternal stress during late gestation is able to impair both humoral and cellular immune function in suckling piglets. The data also suggest that gestational stress in pigs may affect the ontogeny of the foetal immune system with consequences on the susceptibility to diseases and immune responsiveness to stressful stimuli of the offspring.

Adrenocorticotropic Hormone↗
PubMed1999

Effects of dominance and familiarity on behaviour and plasma stress hormones in growing pigs during social confrontation.

Behavioural patterns and plasma adrenaline, noradrenaline and cortisol responses were studied in domestic pigs with different dominance status during 10-h social confrontation tests with a familiar and an unfamiliar group. Eight trials were carried out, where in each trial two groups of nine growing pigs (12 weeks old) were randomly formed. The pigs with the highest (HR) and lowest (LR) rank from each group were selected as test animals, provided with surgically implanted catheters and kept in single housing for 2 to 3 weeks. After this period, each test animal was introduced once into the familiar and once into the unfamiliar group for 10 h. Introduction of the test animals into the groups caused frequent agonistic interactions during the first 30 min and significantly more agonistic interactions during the confrontation with the unfamiliar group. The agonistic behaviour was accompanied by a rapid increase of plasma catecholamines and cortisol. HR pigs showed significantly higher plasma catecholamine concentrations and more agonistic interactions during the first 30 min compared with the LR pigs. During confrontation with the unfamiliar group, HR pigs experienced more defeats and showed a higher increase of plasma cortisol levels than during the confrontation with the familiar group. No influences of rank or familiarity were found on the other behavioural patterns examined. The results show that agonistic behaviour and activation of the sympatho-adrenomedullary and the hypothalamic-pituitary-adrenal system in pigs during a social confrontation test are determined by the former dominance rank of the animals and the familiarity of the group.

Animals↗
PubMed1998

Effects of weaning and restraint stress on glucocorticoid receptor binding capacity in limbic areas of domestic pigs.

Changes in glucocorticoid receptor (GR) binding in different brain areas were investigated in neonatal and adult pigs exposed to psychological stress (weaning) and a physical stressor (repeated snaring). The GR binding was significantly decreased 4 days after weaning in both the hippocampus and the amygdala, but there were no changes in the hypothalamus. Repeated snaring of adult pigs resulted in a significant diminished GR binding only in the hippocampus.

Animals↗
PubMed1997

Development of prosocial, individualistic, and competitive orientations: theory and preliminary evidence.

The authors adopt an interdependence analysis of social value orientation, proposing that prosocial, individualistic, and competitive orientations are (a) partially rooted in different patterns of social interaction as experienced during the periods spanning early childhood to young adulthood and (b) further shaped by different patterns of social interaction as experienced during early adulthood, middle adulthood, and old age. Congruent with this analysis, results revealed that relative to individualists and competitors, prosocial individuals exhibited greater levels of secure attachment (Studies 1 and 2) and reported having more siblings, especially sisters (Study 3). Finally, the prevalence of prosocials increased--and the prevalence of individualists and competitors decreased--from early adulthood to middle adulthood and old age (Study 4).

Adolescent↗
PubMed1997

Influences of breed, sex, and susceptibility to malignant hyperthermia on lipid composition of skeletal muscle and adipose tissue in swine.

OBJECTIVE: To determine influences of breed, sex, and susceptibility to malignant hyperthermia on composition of skeletal muscle and adipose tissue in swine. ANIMALS: 35 male and female swine of German Landrace and Pietrain breeds and of 2 genotypes, normal (MHN) and susceptible to malignant hyperthermia (MHS). PROCEDURE: Pigs were fed a standard diet ad libitum. After attaining body weight of approximately 100 kg, pigs were slaughtered and skeletal (longissimus thoracis and supraspinatus) muscle and adipose tissue (3 sites) specimens were removed. For each specimen, lipids were extracted by chloroform/methanol and fatty acid (FA) pattern, and cholesterol concentration was determined by gas chromatography. RESULTS: The overall lipid contents differed significantly between breeds and genotypes; the MHS Pietrain pigs had the lowest lipid quantities. The relative amounts of saturated FA in all tissues were highest in Landrace pigs (P < 0.05), whereas the relative contents of monoenic FA were lower. In addition, for both breeds, the MHN pigs had significantly higher saturated and lower polyunsaturated FA values in all tissues, compared with MHS pigs. More specifically, MHS females of both breeds had the highest relative amounts of polyunsaturated FA. In general, relative cholesterol contents were found to vary little between identified groups. CONCLUSIONS: These data may indicate that, not only does mutation of the calcium release channel of the sarcoplasmatic reticulum, which occurs in MHS swine, influence secondary changes in lipid composition, but so do hormone concentrations and other genotypic factors. Observed differences in lipid content and FA composition could consequently influence specific membrane properties, such as fluidity and cell signaling.

Adipose Tissue↗