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  1. Article ; Online: History and current status of the survivorship care program at the University of California, Los Angeles Jonsson Comprehensive Cancer Center (UCLA JCCC).

    Brauer, Eden R / Ganz, Patricia A

    Journal of cancer survivorship : research and practice

    2024  Volume 18, Issue 1, Page(s) 5–10

    Abstract: As one of the first comprehensive cancer centers to receive a designation from the National Cancer Institute, the Jonsson Comprehensive Cancer Center at UCLA Health has served as a leader in survivorship research for three decades. A clinical ... ...

    Abstract As one of the first comprehensive cancer centers to receive a designation from the National Cancer Institute, the Jonsson Comprehensive Cancer Center at UCLA Health has served as a leader in survivorship research for three decades. A clinical survivorship program for childhood cancer survivors was established in the early 2000s as this became a standard of care in pediatric oncology. However, it was not until receipt of external funding and the establishment of a Survivorship Center of Excellence in 2006 that clinical services were expanded to include adult cancer survivors, as well as survivorship care delivery research in the community and at affiliated clinical sites. When this funding ended, there was limited institutional support for expansion of the program, and so the clinical programs did not develop further. Recently, there has been renewed interest in obtaining Commission on Cancer accreditation, and this has prompted an institutional assessment of survivorship care to inform future activities for system-wide program development. As oncology care expands throughout a large regional health system network, the future survivorship program will need to serve as a common resource for the entire health system by providing a repository of specialized services and resources as well as standard processes and pathways for a cohesive approach to care. IMPLICATIONS FOR CANCER SURVIVORS: There are many challenges to development and sustainment of cancer survivorship programs, even in NCI-designated comprehensive cancers. As the delivery of cancer care services expands and becomes more integrated in large health care systems, innovative strategies are needed to ensure delivery of tailored care to cancer survivors through acute treatment and beyond.
    MeSH term(s) Adult ; Child ; Humans ; Survivorship ; Cancer Survivors ; Los Angeles ; Delivery of Health Care ; Neoplasms/therapy
    Language English
    Publishing date 2024-01-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-023-01522-x
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  2. Article ; Online: Moving the Translational Needle in Breast Cancer Survivorship: Connecting Intervention Research to Clinical Practice.

    Brauer, Eden R / Ganz, Patricia A

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology

    2022  Volume 40, Issue 19, Page(s) 2069–2073

    MeSH term(s) Breast ; Breast Neoplasms/therapy ; Cancer Survivors ; Female ; Humans ; Survivorship
    Language English
    Publishing date 2022-04-19
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 604914-x
    ISSN 1527-7755 ; 0732-183X
    ISSN (online) 1527-7755
    ISSN 0732-183X
    DOI 10.1200/JCO.22.00174
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  3. Article ; Online: Survivorship care in breast cancer: understanding implementation barriers through the lens of the Theoretical Domains Framework.

    Brauer, Eden R / Petersen, Laura / Ganz, Patricia A

    JNCI cancer spectrum

    2023  Volume 8, Issue 1

    Abstract: Background: Breast cancer survivorship guidelines with specific recommendations on managing long-term effects are available, but uptake in clinical practice remains low. Using the lens of the Theoretical Domains Framework, we aimed to understand key ... ...

    Abstract Background: Breast cancer survivorship guidelines with specific recommendations on managing long-term effects are available, but uptake in clinical practice remains low. Using the lens of the Theoretical Domains Framework, we aimed to understand key factors in guideline-concordant management of long-term effects to inform future implementation efforts in clinical practice contexts.
    Methods: As part of a broader survey of oncologists, a theory-guided questionnaire was developed. Oncologists were asked to report level of agreement with Theoretical Domains Framework-based statements, current usage and perceived value of survivorship resources, and frequency of managing long-term effects in routine care. Data analyses included psychometric assessment of the questionnaire, descriptive summaries of theoretical domains and survivorship resources, and multivariable logistic regression models.
    Results: In total, 217 oncologists completed the Theoretical Domains Framework-based questionnaire; 54% of oncologists reported "always or almost always" evaluating physical effects at routine survivorship appointments, while 34% did so for psychosocial effects. In regression models, Environmental Context and Resources was the only theoretical domain found to be statistically significantly associated with "always or almost always" evaluating both physical (odds ratio = 0.29, 95% confidence interval = 0.09 to 0.80) and psychosocial (odds ratio = 0.09, 95% confidence interval = 0.02 to 0.35) effects.
    Conclusions: Findings support application of the Theoretical Domains Framework in understanding oncologists' behaviors and perceived barriers in managing long-term effects in breast cancer survivors. In future implementation efforts, this theory-informed approach can be used to target relevant domains and strategies focused on embedding guideline recommendations in the clinical context through structured resources and environmental supports.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/therapy ; Survivorship ; Cancer Survivors ; Surveys and Questionnaires
    Language English
    Publishing date 2023-12-21
    Publishing country England
    Document type Journal Article
    ISSN 2515-5091
    ISSN (online) 2515-5091
    DOI 10.1093/jncics/pkad108
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  4. Article ; Online: A mixed method study of medical oncologists' perceived barriers and motivators to addressing long-term effects in breast cancer survivors.

    Fauer, Alex J / Ganz, Patricia A / Brauer, Eden R

    Breast cancer research and treatment

    2022  Volume 194, Issue 3, Page(s) 699–707

    Abstract: Purpose: The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.: Methods: This study is a secondary analysis of data from a survey of U.S. medical ... ...

    Abstract Purpose: The purpose of this study was to identify oncologist-reported barriers and motivators in addressing long-term effects with breast cancer survivors.
    Methods: This study is a secondary analysis of data from a survey of U.S. medical oncologists (n = 217) about breast cancer survivorship care in clinical practice. Using both closed- and open-ended questions, we asked oncologists to report barriers and motivators they perceived in addressing long-term effects with breast cancer patients. Descriptive statistics were used to summarize and rank items endorsed by oncologists in analyses of quantitative data; content analysis was used to identify salient categories of barriers and motivators in qualitative data.
    Results: Key barriers to managing physical long-term effects included lack of time during appointments (n = 128 oncologists, 59%) and perceived lack of evidence-based interventions (n = 89, 41%). With respect to psychosocial effects, oncologists reported lack of knowledge (n = 88, 40.6%) and challenges making referrals to mental health providers (n = 115, 53%). From the qualitative data, three distinct barrier categories emerged: "Competing priorities during brief appointments;" "Discussing long-term effects-Who? What? When?;" and "Beyond my expertise and comfort level." Two motivator categories emerged: "I owe it to them;" and "Giving people a life worth living."
    Conclusion: Oncologists' key motivators for addressing long-term effects were focused on professional values, relationships with survivors, and their commitment to prioritizing patients' quality of life. Future efforts should leverage oncologists' professional and interpersonal motivators to enhance the delivery of survivorship care for breast cancer.
    MeSH term(s) Breast Neoplasms/psychology ; Breast Neoplasms/therapy ; Cancer Survivors ; Female ; Humans ; Neoplasms ; Oncologists ; Quality of Life ; Survivors/psychology
    Language English
    Publishing date 2022-06-29
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 604563-7
    ISSN 1573-7217 ; 0167-6806
    ISSN (online) 1573-7217
    ISSN 0167-6806
    DOI 10.1007/s10549-022-06657-6
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    Zs.A 1655: Show issues Location:
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  5. Article ; Online: Health burden in cancer survivors: below the tip of the iceberg.

    Brauer, Eden R / Ganz, Patricia A

    Nature reviews. Clinical oncology

    2019  Volume 16, Issue 8, Page(s) 467–468

    MeSH term(s) Adult ; Cancer Survivors ; Denmark ; Humans
    Language English
    Publishing date 2019-05-16
    Publishing country England
    Document type Journal Article ; Comment
    ZDB-ID 2491410-1
    ISSN 1759-4782 ; 1759-4774
    ISSN (online) 1759-4782
    ISSN 1759-4774
    DOI 10.1038/s41571-019-0226-0
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  6. Article ; Online: Financial Vulnerability: A Case Study Involving a Patient With Head and Neck Cancer.

    Brauer, Eden / Morasso, Elizabeth

    Clinical journal of oncology nursing

    2019  Volume 23, Issue 5, Page(s) 31–35

    Abstract: Background: Patients with head and neck cancer (HNC) face unique financial challenges. Even with stable income and health insurance, many patients become overwhelmed with direct and indirect treatment-associated costs.: Objectives: This article ... ...

    Abstract Background: Patients with head and neck cancer (HNC) face unique financial challenges. Even with stable income and health insurance, many patients become overwhelmed with direct and indirect treatment-associated costs.
    Objectives: This article discusses how prolonged financial burden in patients with cancer can result in compromised patient outcomes.
    Methods: A case study is presented that highlights financial burden associated with reduced income, treatment-related commuting, and challenges in resuming a job while dealing with functional impairments and long-term treatment effects from HNC. It also describes the financial impact on a spousal caregiver.
    Findings: Nurses must initiate discussions with their patients about potential and actual financial concerns and barriers to care. In addition, nurses should include repeated assessment of financial health throughout the cancer care trajectory and provide appropriate resources and referrals when issues are identified.
    MeSH term(s) Alphapapillomavirus/isolation & purification ; Caregivers/economics ; Cost of Illness ; Financing, Personal ; Humans ; Male ; Middle Aged ; Oropharyngeal Neoplasms/economics ; Oropharyngeal Neoplasms/physiopathology ; Oropharyngeal Neoplasms/therapy ; Oropharyngeal Neoplasms/virology
    Language English
    Publishing date 2019-09-20
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2014665-6
    ISSN 1538-067X ; 1092-1095
    ISSN (online) 1538-067X
    ISSN 1092-1095
    DOI 10.1188/19.CJON.S2.31-35
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    Zs.A 5229: Show issues Location:
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  7. Article ; Online: Current practice patterns and gaps in guideline-concordant breast cancer survivorship care.

    Brauer, Eden R / Long, Elisa F / Petersen, Laura / Ganz, Patricia A

    Journal of cancer survivorship : research and practice

    2021  Volume 17, Issue 3, Page(s) 906–915

    Abstract: Purpose: Breast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated ... ...

    Abstract Purpose: Breast cancer-specific survivorship care guidelines for the more than 3.8 million survivors in the U.S. are available, but implementation in clinical practice remains challenging. We examined current practice patterns and factors associated with guideline-concordant survivorship care among oncologists.
    Methods: A national sample of medical oncologists, recruited using two databases, participated in a survey focused on practice patterns for breast cancer survivorship care. A "survivorship care composite score" was calculated for each respondent based on provision of services recommended in the survivorship guidelines. Descriptive statistics and multivariable linear regression analyses examined associations between physician and practice characteristics and composite scores.
    Results: The survey was completed by 217 medical oncologists, with an overall response rate of 17.9% and eligibility rate of 56.9% for those who responded. Oncologists reported high engagement in evaluation of disease recurrence (78%). Performed less frequently were the provision of survivorship care plans (46%), assessment of psychosocial long-term and late effects (34%), and screening for subsequent cancers (34%). Lack of survivorship care training (p = 0.038) and not routinely informing patients about potential late effects (p = 0.003) were significantly associated with poorer survivorship care composite scores.
    Conclusions: Despite the availability of disease-specific survivorship care guidelines, adherence to their recommendations in clinical practice is suboptimal. Survey results identified key gaps in survivorship care for breast cancer survivors, particularly related to subsequent primary cancers and psychosocial long-term and late effects.
    Implications for cancer survivors: Improving the delivery of comprehensive survivorship care for the growing population of breast cancer survivors is a high priority. Disease-specific clinical guidelines for cancer survivorship provide valuable recommendations, but innovative strategies are needed to integrate them into the care of long-term breast cancer survivors.
    MeSH term(s) Humans ; Female ; Breast Neoplasms/epidemiology ; Cancer Survivors ; Survivorship ; Neoplasm Recurrence, Local ; Survivors/psychology
    Language English
    Publishing date 2021-12-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2388888-X
    ISSN 1932-2267 ; 1932-2259
    ISSN (online) 1932-2267
    ISSN 1932-2259
    DOI 10.1007/s11764-021-01152-1
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  8. Article ; Online: Health Care Providers' Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study.

    Brauer, Eden / Choi, Kristen / Chang, John / Luo, Yi / Lewin, Bruno / Munoz-Plaza, Corrine / Bronstein, David / Bruxvoort, Katia

    JMIR infodemiology

    2021  Volume 1, Issue 1, Page(s) e33330

    Abstract: Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines.: Objective: ... ...

    Abstract Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines.
    Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients.
    Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines.
    Results: The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%;
    Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources.
    Language English
    Publishing date 2021-12-08
    Publishing country Canada
    Document type Journal Article
    ISSN 2564-1891
    ISSN (online) 2564-1891
    DOI 10.2196/33330
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  9. Article ; Online: "Winging It": How Older Breast Cancer Survivors Persist With Aromatase Inhibitor Treatment.

    Brauer, Eden R / Ganz, Patricia A / Pieters, Huibrie C

    Journal of oncology practice

    2016  Volume 12, Issue 12, Page(s) e991–e1000

    Abstract: Purpose: Aromatase inhibitors (AIs) are an important and effective hormonal adjuvant treatment for early-stage breast cancer. Up to 50% of women stop AIs prematurely, missing a valuable therapeutic intervention.: Patients and methods: We used ... ...

    Abstract Purpose: Aromatase inhibitors (AIs) are an important and effective hormonal adjuvant treatment for early-stage breast cancer. Up to 50% of women stop AIs prematurely, missing a valuable therapeutic intervention.
    Patients and methods: We used grounded theory methodology to conduct in-depth, semistructured interviews and analyze data among patients with breast cancer diagnosed at age 65 years or older who were receiving an AI. The goal of the interviews was to understand decision making regarding persisting with AIs. Interview transcripts were systematically analyzed to identify emergent categories and relationships.
    Results: Interviews were conducted with 27 women. After completion of primary treatment, women in our sample found themselves "winging it" as they faced substantial struggles with infrequent support during this new phase of the cancer trajectory. Self-management of AI adverse effects occurred in the contexts of older age and early survivorship. "Bearing it" emerged as another important management process regarding the impact of AIs on quality of everyday life. The complex decision to persist with the AI involved weighing the possibility of a cancer-free future against the burden of adverse effects. Women relied on informal networks for support, rather than oncology providers, highlighting the need for practical self-management strategies. The notion of a tipping point in persistence revealed their susceptibility to early discontinuation.
    Conclusion: This study provides insight into potential decisional pathways leading to early discontinuation of AIs among older women with breast cancer. Better support is needed for these women.
    MeSH term(s) Age Factors ; Aged ; Aged, 80 and over ; Aromatase Inhibitors/adverse effects ; Aromatase Inhibitors/therapeutic use ; Breast Neoplasms/drug therapy ; Decision Making ; Female ; Humans ; Quality of Life ; Survivors
    Chemical Substances Aromatase Inhibitors
    Language English
    Publishing date 2016-09-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2236338-5
    ISSN 1935-469X ; 1554-7477
    ISSN (online) 1935-469X
    ISSN 1554-7477
    DOI 10.1200/JOP.2016.011767
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  10. Article ; Online: Coming of Age With Cancer: Physical, Social, and Financial Barriers to Independence Among Emerging Adult Survivors

    Brauer, Eden / Pieters, Huibrie C / Ganz, Patricia A / Landier, Wendy / Pavlish, Carol / Heilemann, MarySue V

    Oncology nursing forum

    2018  Volume 45, Issue 2, Page(s) 148–158

    Abstract: Purpose: To explore the transition to self-care among a sample of emerging adult cancer survivors after hematopoietic cell transplantation (HCT). 
.: Participants & setting: 18 HCT survivors who were aged 18-29 years at the time of HCT for a primary ... ...

    Abstract Purpose: To explore the transition to self-care among a sample of emerging adult cancer survivors after hematopoietic cell transplantation (HCT). 
.
    Participants & setting: 18 HCT survivors who were aged 18-29 years at the time of HCT for a primary hematologic malignancy and were 8-60 months post-HCT participated in the study. The study took place in the hematology outpatient setting at City of Hope National Medical Center.
.
    Methodologic approach: The authors conducted in-depth semistructured interviews and analyzed interview transcripts using grounded theory methodology.
.
    Findings: Health-related setbacks following HCT disrupted not only participants' journey toward self-care, but also their overarching developmental trajectory toward adulthood. Physically, participants struggled with lack of personal space around caregivers, but felt unready to live on their own. Socially, they relied on multiple caregivers to avoid relying too much on any one person. Financially, participants worried about prolonged dependence and increased needs in the future.
.
    Implications for nursing: Nurses can support the transition to self-care among emerging adults after HCT by recognizing the broader developmental impact of their cancer experience.
    MeSH term(s) Adaptation, Psychological ; Adolescent ; Adult ; Age Factors ; Cancer Survivors/psychology ; Cancer Survivors/statistics & numerical data ; Female ; Hematologic Neoplasms/economics ; Hematologic Neoplasms/psychology ; Hematologic Neoplasms/therapy ; Hematopoietic Stem Cell Transplantation/economics ; Hematopoietic Stem Cell Transplantation/psychology ; Humans ; Male ; Young Adult
    Language English
    Publishing date 2018-02-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 604886-9
    ISSN 1538-0688 ; 0190-535X ; 1538-0688
    ISSN (online) 1538-0688 ; 0190-535X
    ISSN 1538-0688
    DOI 10.1188/18.ONF.148-158
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