Entscheidungsfindungsprozesse und alternative Formen der Beratung (German Edition)

Fertility-preserving surgery for various tumor entities is discussed in Chapter 4. Radiogenic tubal changes can lead to a loss of function, resulting in limited fertility. Extrauterine pregnancies and their associated subsequent complications can occur, even if ovarian and uterine function have been preserved. Nothing is known about tubal tolerance doses. In contrast to chemotherapy, radiotherapy can affect uterine function in addition to affecting the ovaries. Here again, the effect depends on the dose; the dose-response relationship has not yet been clearly defined 7.

Flow diagram of potential approaches to protect the fertility of girls and women after the onset of menarche before they start gonadotoxic therapy. Fertility protection for women based on oncologic therapy and the available timeframe modified from 1. There are a number of S3 guidelines on the treatment of patients with malignant ovarian tumors, cervical cancer und endometrial cancer.

To prevent discrepancies between guidelines, the guideline coordinators of the S3 guidelines and the coordinators of the S2k guideline on fertility preservation unanimously agreed to incorporate the relevant Statements, Recommendations and background texts from the S3 guidelines into the S2k guideline. The relevant Recommendations and Statements are available in the long version of the guideline.

The standard chemotherapy protocols to treat breast cancer in young women are anthracycline- and taxane-based chemotherapies. A recent systematic meta-analysis about the use of GnRHa in women with breast cancer 26 evaluated the data from women, of whom received chemotherapy without GnRHa and of whom were treated with chemotherapy and GnRHa The rate of spontaneous menstruation recurrence after completing chemotherapy was higher in the group treated with concomitant GnRHa OR: However, there was no significant difference in pregnancy rates between the two groups.

In addition to the established methods to protect fertility before and after treatment for malignant disease mainly targeting post-pubertal boys and girls, experimental methods are also available, particularly for prepubertal children. Listed below are instructions concerning the use of fertility protection methods which need to be taken into account before starting therapy.

A standard operating procedure SOP on managing the contact with a patient before the patient starts oncologic treatment which will reduce their fertility while the patient may still want to have children is included in the appendix of the long German version of the guideline, together with leaflets on preserving fertility which were compiled together with the German Cancer Society DKG.

• Old Shock;
• Prof. Dr. Michael Kaeding - Forschung.
• The questions of choice and morals in The Spoils of Poynton.
• !
• Forschungsfelder.
• .
• Emergency Neurology.

Hier sind vor allem zu nennen: Die Methodik zur Erstellung dieser Leitlinie wird durch die Vergabe der Stufenklassifikation vorgegeben. Im Jahr wurde die Stufe S2 in die systematische evidenzrecherchebasierte S2e oder strukturelle konsensbasierte Unterstufe S2k gegliedert. Die Evidenzgraduierung und Empfehlungsgraduierung einer Leitlinie auf S2k-Niveau ist nicht vorgesehen.

Es werden die einzelnen Empfehlungen nur sprachlich — nicht symbolisch — unterschieden. Stock, AT Innsbruck stephanie. National Center for Biotechnology Information , U. Published online Jun Ramona Beck 6 Frauenselbsthilfe nach Krebs e. Author information Article notes Copyright and License information Disclaimer.

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. Abstract Aim The aim of this official guideline published by the German Society of Gynecology and Obstetrics DGGG and coordinated with the German Society of Urology DGU and the German Society of Reproductive Medicine DGRM is to provide consensus-based recommendations, obtained by evaluating the relevant literature, on counseling and fertility preservation for prepubertal girls and boys as well as patients of reproductive age.

Zusammenfassung

Guideline documents The complete long version of the guideline in German, a PDF slideshow for PowerPoint presentations and a summary of the conflicts of interest of all authors are available on the homepage of the AWMF: Laura Lotz Guidelines secretary Prof. Roxana Schwab Expert Dip. Open in a separate window. Targeted areas of patient care Outpatient care. Target patient groups The guideline is aimed at all prepubertal girls and patients of reproductive age who require gonadotoxic treatment for malignant disease. Adoption of the guideline and period of validity This guideline is valid from November 1, to October 31, This guideline is classified as: Statements Expert statements included in this guideline which are not recommendations for action but simple statements of fact are referred to as Statements.

Conditioning for stem cell transplantation particularly alkylating agent-based myeloablative conditioning with busulfan, cyclophosphamide, melphalan. Not all patients in a specific age group who receive therapy according to a defined regimen will develop the same fertility disorder. A gonadotoxic effect is unlikely. The harvested tissue must be processed promptly, at the very latest 24 hours after harvesting.

High risk Moderate risk Low risk leukemia. The risk of recurrence caused by transplantation of the tissue cannot be excluded and must be discussed with the patient before harvesting ovarian tissue. The risk of disease recurrence caused by transplantation cannot be excluded and must be discussed with the patient before harvesting ovarian tissue. This can help prevent thrombocytopenic menorrhagia. Women who were treated with a conditioning protocol to prepare them for stem cell transplantation have a high risk of infertility.

Patients treated with a conventional protocol have a low risk of infertility. Women treated with a conditioning protocol to prepare them for stem cell transplantation have a high risk of infertility. These patients must be informed and receive counseling about methods to protect their fertility. GnRH agonists must not be administered to prepubertal patients. The recommendation for ovariopexy must be discussed with the patient and her family.

This must be done before starting treatment for malignant disease if cancer therapy can be postponed by 2 weeks. The decision for or against cryopreservation requires the type of therapy and the gonadotoxic dose to be weighed up in each individual case. The patient and his family must be informed about these options. The subsequent maturation of sperm from spermatogonial stem cells, which would be necessary for this approach, is currently not yet possible in humans. Transplanting cryopreserved tissue always carries the risk of transplanting malignant cells.

Information about the options for and the limits of fertility protection should be made available to affected patients both orally and in writing e.

Prof. Dr. Michael Kaeding - Forschung

Appendix to the Guideline A standard operating procedure SOP on managing the contact with a patient before the patient starts oncologic treatment which will reduce their fertility while the patient may still want to have children is included in the appendix of the long German version of the guideline, together with leaflets on preserving fertility which were compiled together with the German Cancer Society DKG. Having children after cancer. Decision-making in female fertility preservation is balancing the expected burden of fertility preservation treatment and the wish to conceive.

American Society of Clinical Oncology recommendations on fertility preservation in cancer patients. Cancer and fertility preservation: Predicting age of ovarian failure after radiation to a field that includes the ovaries. Fertility and pregnancy outcome after abdominal irradiation that included or excluded the pelvis in childhood tumor survivors. Human oocyte cryopreservation with slow freezing versus vitrification. Results from the National Italian Registry data, — A randomized controlled trial comparing two vitrification methods versus slow-freezing for cryopreservation of human cleavage stage embryos.

J Assist Reprod Genet. Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: Optimizing outcomes from ovarian tissue cryopreservation and transplantation; activation versus preservation. Risk of transferring malignant cells with transplanted frozen-thawed ovarian tissue.

Autotransplantation of cryopreserved ovarian tissue in cancer survivors and the risk of reintroducing malignancy: Incidence and time course of bleeding after long-term amenorrhea after breast cancer treatment: Fertility preservation options for young women with breast cancer. Curr Opin Obstet Gynecol.

Fertility conservation in breast cancer patients. Womens Health Lond ; 7: Safety and feasibility of performing two consecutive ovarian stimulation cycles with the use of letrozole-gonadotropin protocol for fertility preservation in breast cancer patients. Fertility preservation in female cancer patients: The role of menstrual cycle phase and AMH levels in breast cancer patients whose ovarian tissue was cryopreserved for oncofertility treatment. Association of BRCA1 mutations with occult primary ovarian insufficiency: Age-related decline in DNA repair function explains diminished ovarian reserve, earlier menopause, and possible oocyte vulnerability to chemotherapy in women with BRCA mutations.

Utility of gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage in premenopausal women with breast cancer: Ovarian suppression using luteinizing hormone-releasing hormone agonists during chemotherapy to preserve ovarian function and fertility of breast cancer patients: Copyright and License information Disclaimer. Jens Hirchenhain Arbeitsgemeinschaft Reproduktionsbiologie des Menschen e.

Jana Liebenthron Fertiprotekt Netzwerk e. Frank Nawroth Fertiprotekt Netzwerk e. Verena Nordhoff Arbeitsgemeinschaft Reproduktionsbiologie des Menschen e.

Die Kunst der Entscheidungsfindung | ESMT Berlin

Falk Ochsendorf Deutsche Dermatologische Gesellschaft e. Roxana Schwab Experte Dip. Petra Thorn Beratungsnetzwerk Kinderwunsch Deutschland e. Beratungsnetzwerk Kinderwunsch Deutschland e.

Diese Leitlinie entspricht der Stufe: Eine gonadotoxische Wirkung ist nicht wahrscheinlich. GnRH-Agonisten im Jugendalter ist bislang noch fraglich. Die Empfehlung soll mit der Patientin und der Familie besprochen werden. Dies soll vor Therapiebeginn stattfinden, wenn dieser um 2 Wochen verschoben werden kann. Bei Transplantation des kryokonservierten Gewebes besteht die Gefahr der Transplantation von malignen Zellen. Support Center Support Center. Policy and Politics 36 2: Lost in Translation or Full Steam Ahead? Romeijn "The transposition of EC directives. Journal of Public Policy 26 3: The Case of the Cargegana Protocol on Biosafety", in: Journal of Common Market Studies 44 5: Sie trennen tausende Kilometer und politisch Welten: Dennoch sind Zentralasien und die EU wichtige Partner geworden.

Kasachstan, Kirgisistan, Tadschikistan, Turkmenistan und Usbekistan: Dass sich dort stabile und demokratische Gesellschaften entwickeln, ist auch im Interesse Europas. The Future of Europe. Views from the Capitals , Kaeding, M. With a Foreword by the President of the European Parliament, Antonio Tajani, this book sheds light on the political dynamics within the EU member states and contributes to the discussions about Europe. Authors from all member states as well as Iceland, Norway, Switzerland and Turkey assess how their country could get more involved in the European debate, taking the reader on a journey through various political landscapes and different views.

The chapters cover issues ranging from a perceived lack of ambition at the periphery to a careful balancing act between diverse standpoints at the geographical centre. Yet, discussions share common features such as the anxiety regarding national sovereignty, the migration and border discourse, security concerns as well as the obvious need to regain trust and create policies that work. The book contributes vigorously to the debate about Europe in all capitals and every corner of the continent, because this is where its future will be decided. A Critical Assessment , Kaeding, M.

European Journal of Risk Regulation 8 4 , pp. Medicinal products are granted market authorisation only after extensive assessment of their quality, safety and effiancy. Nevertheless, all medicines might produce adverse drug reactions, which are only detected after authorised products are being rolled-out to the market.

1. ;
2. .
3. ?

In the past, Eu regulation used to rely primarily on pre-marketing assessment and authorisation for establishing risks and benefits before the marketing of medicinal products. This has changed since the s and today, drug development and manufacturing, clinical trials, market authorisation and pharmacovigilance are regulated in the EU. Sitting between European Politics and National Constraints: Capital and Credit Markets 1. Beyond core functions of central banking, the European Central Bank ECB plays a pivotal role in the new European economic and financial governance framework.

Against this backdrop, this special issue aims at analyzing these recent developments by bringing together insights from different disciplines, such as political science, economics, law, and sociology. Senior and junior scholars and practitioners out of the field apply qualitative as well as quantitative research designs focusing on the political economy of the ECB sitting between European politics and national constraints. The researched questions will be: Why has the ECB become a political leader by default in the new European governance structure?

Please click here for the full issue. EU-Agenturen , Michael Kaeding , in: Overriding the European Commission's rulemaking?

ESMT Berlin is virtually everywhere. Explore the campus, classes and city using virtual reality.

Practical experience in the European Union with post-Lisbon legislative vetoes with quasi-legislative acts, Michael Kaeding , in: Bruges Political Research Papers Particularly interesting, the level of exercise of legislative veto provisions has not increased significantly since the Lisbon Treaty came into effect, suggesting that the ways in which the Treaty formally augmented the powers of legislative scrutiny have not resulted in appreciably greater formal exercise of these powers ultima ratio.

Moreover, no significant differences appear between the Council of Ministers and the European Parliament. The book presents the results of an in-depth comparative study assessing the implementation of the EU Pharmacovigilance Directive in six EU Member States. By going beyond legal transposition and instead focusing on practical implementation, this study aims to close a gap in EU compliance research. Based on qualitative interviews with relevant actors in Germany, Poland, Portugal, France, Finland and the UK, the authors identify perceived challenges and best-practices, issue recommendations, and thereby contribute to a better understanding of the factors that incentivize or impede the practical implementation of EU drug safety at the national level.

Intuition und Bauchgefühl

Politische Gleichheit nicht ohne soziale Gleichheit: Dieser erscheinende Band bietet eine aktuelle Bestandsaufnahme der bestehenden Literatur zur sinkenden Wahlbeteiligung in Europa, Deutschland und Nordrhein-Westfalen. Learning on the job? Journal of Common Market Studies. This article investigates the determinants of assignments to European Parliament negotiating teams comprising both rapporteurs and shadow rapporteurs. We find that Members of the European Parliament MEPs from newer Member states remain considerably less likely to act as rapporteurs during the second term after enlargement Most importantly, this trend also holds for shadow rapporteurs under the co-decision procedure, that is when they matter most.

This structural underrepresentation has potentially important implications for European integration: MEPs from newer Member States are arguably less able to influence legislation. We suggest three readings of the results by asking whether MEPs from these countries are less willing, lacking skills, or disadvantaged.



Future research on rapporteurship allocation and legislative careers should seek to answer these questions. The political situation between Turkey and the EU is getting increasingly delicate. Since , the European Commission has been granted the power to amend legislative acts and not simply implement them.

Based on principles of political economy, we hypothesize that these formal means of oversight will be invoked very infrequently by Parliament and the Council. Welche Neuerungen brachte die Europawahl ?