We conclude that the use of PBPC mobilized by chemotherapy plus G-CSF results in sustained trilineage reconstitution after HDCT, which occurs more rapidly as compared with BM. The earlier hematologic reconstitution in patients with PBPC rescue significantly reduces the time to transfusion independence.

High-dose carboplatin, etoposide, and ifosfamide plus autologous stem-cell transplantation can be used in refractory and relapsed germ cell cancer with acceptable toxicity, and represents an effective, potentially curative salvage treatment.

In times of reduced mortality from myocardial infarction and ageing of the population, the number of patients suffering from chronic heart failure continues to rise. In spite of optimal cardiological treatment, many patients suffer from dyspnoea. The use of commonly used drugs in palliative care such as opioids for the relief of dyspnoea is uncommon in this group of patients. We conducted a limited systematic literature research in order to find out if there is evidence for the use of any systemic pharmacological substance for the symptomatic relief of dyspnoea in chronic heart failure patients. Three randomised controlled trials with opioids could be identified. The quality of the identified studies does not support the avoidance of the use of opioids in patients with chronic heart failure to relieve dyspnoea. But further studies are recommended to support the use of opioids in patients with chronic heart failure for relief of breathlessness to improve the quality of life of this growing population.

Implementation of hospital-based palliative care team is a new subject in German-speaking areas, especially in university hospitals. Our Section of Palliative Care was subsequently built up to a 12-bed palliative care unit, a home-based, and a hospital-based palliative care team. Analysis of the implementation strategies, development of the working profile, and documentation of the hospital-based palliative care team were done. During the first 2 years, quality and number of inquiries for palliative care increased significantly. In our opinion, a high degree of expertise, involvement of the nursing staff, and personal contact play a key role for a successful implementation of a palliative care team in a large university hospital.

ZusammenfassungInfektionen sind häufige Begleiterkrankungen bei Patienten mit fortgeschrittenen Tumorerkrankungen oder anderen unheilbaren Erkrankungen. Im Gegensatz zu anderen Fachgebieten führt in der Palliativmedizin der Verdacht auf eine Infektion jedoch nicht zwangsläufig zu weiteren diagnostischen Maûnahmen und/oder zu einer antibiotischen Therapie. In einer Fokusgruppe sollten beispielhaft für Entscheidungsprozesse in der palliativmedizinischen Therapieplanung die Einstellungen zur antibiotischen Therapie des Palliativteams untersucht und die Praxis beleuchtet werden. Die Diskussion über die vorgestellten Fälle wurde moderiert und protokolliert, sodass die Ergebnisse anhand einer qualitativen Inhaltsanalyse ausgewertet werden konnten. Als zentrale Problembereiche beim Einsatz von Antibiotika wurden die Art der Diagnostik und die Indikation bei Infektionen sowie das Fehlen von einheitlichen Outcomekriterien zur Erfolgskontrolle herausgestellt. Darüber hinaus wurden aus den Erfahrungen der Fokusgruppenteilnehmer verschiedene Hypothesen abgeleitet, wie z. B. die Erhöhung des Antibiotikaeinsatzes wegen abteilungs-und fachspezifischer Standards sowie Angst vor juristischen Konsequenzen bei Therapieverzicht, obwohl im individuellen Fall an deren Wirksamkeit gezweifelt wird. Schlüsselwörter Palliativmedizin´Antibiotika´Therapieentscheidung´Fokus-gruppe AbstractPatients with progredient cancer diseases often suffer additionally from different infections. In contrast to other medical specialities in palliative medicine suspected infections do not necessarily lead to diagnostic measures or antibiotic therapy. A focus group was conducted to discuss the scope of attitudes towards decision making and management of antibiotic therapy in palliative care. The discussion on the casuistics was moderated, i. e. questions and objections were gathered and sorted according to problematic areas. Using qualitative content analysis, the results of the discussion revealed different problemareas, e. g. diagnostic measures, decision about indication and absence of suitable outcome-criteria. In addition, the focus group developed hypotheses which might be useful in describing attitudes of physicians in palliative care such as: ¹Antibiotics are used even though their effectiveness is in doubt because physicians tend to stick to standards that are valid within a certain institution or specialization. In addition to that, legal consequences are feared in case antibiotic therapy is abandonedª.