Gespaltene Fürsorge : Sorgeberufe zwischen Professionalisierung und Freiwilligenarbeit

Im Kontext der Ökonomisierung von Sorgearbeit wird zunehmend auf freiwilliges Engagement zurückgegriffen. Das hat Folgen für Professionalisierungsprozesse in den weiblich typisierten Berufsfeldern. Anhand qualitativ-empirischen Datenmaterials zeigt der Beitrag, dass sich die Vergeschlechtlichung beruflicher Sorgearbeitstätigkeiten in Pflege und Sozialarbeit sowohl als Professionalisierungshemmnis wie auch als Mittel der Bewältigung eines Professionalisierungsdilemmas zu erkennen gibt: Ökonomisierungs- und Rationalisierungsprozesse erzeugen ein Spannungsverhältnis zwischen fürsorglichen und zweckrationalen Tätigkeitsanteilen, das mithilfe der hierarchisierenden Abspaltung und Auslagerung weiblich konnotierter und abgewerteter Beziehungsarbeit in das Engagement beantwortet wird. Die Folge ist eine einseitige Professionalisierung, die sowohl auf Kosten guter professioneller Sorgearbeit als auch zu Lasten Freiwilliger geht

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

Background: A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix (R) Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan (R) Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. Methods: An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. Results: Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; P-Chi < .001). Operators rated the handling of VS as superior (rating of"good" or"very good: 86.1% VS vs. 20.8% IS, P-Chi <.001). Reinsertion of the needle into the catheter after partial withdrawal-prior or during the catheterization attempt-was associated with an increased risk of cannulation failure (7.909, CI 5.989-10.443, P < .001 and 23.023, CI 10.372-51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347-2.967, P = .001). Conclusions: First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure

Internal morphology of 101 mandibular canines of a Swiss-German population by means of micro-CT: An ex vivo study

The aim of this study was to investigate the root canal system morphology by means of a root canal configuration (RCC) classification described with a four-digit system, the physiological foramen geometry and accessory canal frequency and morphology, of 101 mandibular canines (MaCa) of a Swiss-German population by means of micro-computed tomography. Micro-CT examination of the MaCa was performed and the obtained images analyzed with a 3D imaging software. In single-rooted MaCas, the most frequently observed RCCs were 1-1-1/1 (74.5%) and 1-1-1/2 (14.3%). Seven other RCCs were less frequently observed with a frequency from 4.1 to 1.0%. One physiological foramen was observed in 80.6% of the MaCas, two in 16.3%, three in 1.0% and four in 2.0%. Accessory and connecting canals were apparent only in the middle and apical root thirds. Two-rooted MaCas occurred less frequently (n = 3). When one physiological foramen was present, the mean size of the narrow and wide diameters were 0.28 mm (±0.07) and 0.40 mm (±0.11), while the distance between physiological and anatomical foramen was 0.45 mm (±0.17). MaCas are predominantly single-rooted teeth with a 1-1-1/1 or 1-1-1/2 RCC. Most MaCas had one physiological foramen with an oval shape

Comparison of MICs in Escherichia coli isolates from human health surveillance with MICs obtained for the same isolates by broth microdilution

Objectives Human health surveillance and food safety monitoring systems use different antimicrobial susceptibility testing (AST) methods. In this study, we compared the MICs of Escherichia coli isolates provided by these methods. Methods E. coli isolates (n = 120) from human urine samples and their MICs were collected from six medical laboratories that used automated AST methods based on bacterial growth kinetic analyses. These isolates were retested using broth microdilution, which is used by the food safety monitoring system. The essential and categorical agreements (EA and CA), very major errors (VME), major errors (ME) and minor errors (mE) for these two methods were calculated for 11 antibiotics using broth microdilution as a reference. For statistical analysis, clinical breakpoints provided by EUCAST were used. Results Five study laboratories used VITEK®2 and one MicroScan (Walkaway Combo Panel). Out of 120 isolates, 118 isolates (98.3%) were confirmed as E. coli. The 99 E. coli isolates from five study laboratories that used VITEK®2 showed high proportions of EA and CA with full agreements for gentamicin, meropenem, imipenem and ertapenem. Additionally, 100% CA was also observed in cefepime. Few VME (0.5%), ME (1.9%) and mE (1.5%) were observed across all antibiotics. One VME for ceftazidime (7.1%) and 12 MEs for ampicillin (29.4%), cefotaxime (2.4%), ciprofloxacin (3.2%), tigecycline (1.5%) and trimethoprim (22.2%) were detected. Conclusions MICs from E. coli isolates produced by VITEK®2 were similar to those determined by broth microdilution. These results will be valuable for comparative analyses of resistance data from human health surveillance and food safety monitoring systems

Transfusion of red blood cells does not impact progression‐free and overall survival after surgery for ovarian cancer

BACKGROUND: Allogeneic red blood cells (RBCs) have the potential to impact the immunosurveillance of the recipient and may therefore increase the risk of recurrence after cancer surgery. In this article the relationship between perioperative RBC transfusion and the risk of recurrence after ovarian cancer surgery is examined. STUDY DESIGN AND METHODS: This is a retrospective cohort analysis of a prospective database of patients who underwent surgery due to primary ovarian cancer between 2006 and 2014 and who had no residual disease after surgery. Patients who did and did not receive perioperative RBC transfusion were compared. The primary endpoint was progression-free survival (PFS). Propensity score matching (PSM) and Cox proportional hazards regression (CPH) was used to control for between-group differences of prognostic determinants. RESULTS: A total of 529 patients with a median follow-up of 51.4 months (95% CI, 46.1-56.5) were eligible for analysis. Of those, 408 patients (77.1%) received allogeneic, leukoreduced RBCs with a median of 4 units (IQR, 2-6) per patient. There was a strong selection bias of prognostic determinants between patients with and without transfusion. In unadjusted analysis, transfusion of RBCs was associated with an increased risk of cancer recurrence (hazard ratio [HR] of PFS 2.71 [95% CI, 1.94-3.77], p < 0.001). After bias reduction, transfusion of RBCs was no longer associated with an increased risk of cancer recurrence, neither in PSM-adjusted (HR 1.03 [95% CI, 0.59-1.80], p = 0.91), nor in multivariable CPH-adjusted analysis (HR 1.26 [95% CI, 0.85-1.86], p = 0.23). CONCLUSION Perioperative transfusion of RBCs did not increase the risk of recurrence after ovarian cancer surgery

Projekt Curriculumforschung: Grundstudium Psychologie (Bielefeld)

Geil-Werneburg E, Günther-Boemke G, Günther F, Hermsen H. Projekt Curriculumforschung: Grundstudium Psychologie (Bielefeld). In: Göpel E, ed. Humanisierung des Gesundheitswesens. Arbeitsfeldmaterialien zum Sozial- und Gesundheitsbereich ; 9. Offenbach: Verl. 2000; 1979: 113-116

In vitro validation and characterization of pulsed inhaled nitric oxide administration during early inspiration

Purpose: Admixture of nitric oxide (NO) to the gas inspired with mechanical ventilation can be achieved through continuous, timed, or pulsed injection of NO into the inspiratory limb. The dose and timing of NO injection govern the inspired and intrapulmonary effect site concentrations achieved with different administration modes. Here we test the effectiveness and target reliability of a new mode injecting pulsed NO boluses exclusively during early inspiration. Methods: An in vitro lung model was operated under various ventilator settings. Admixture of NO through injection into the inspiratory limb was timed either (i) selectively during early inspiration ("pulsed delivery"), or as customary, (ii) during inspiratory time or (iii) the entire respiratory cycle. Set NO target concentrations of 5-40 parts per million (ppm) were tested for agreement with the yield NO concentrations measured at various sites in the inspiratory limb, to assess the effectiveness of these NO administration modes. Results: Pulsed delivery produced inspiratory NO concentrations comparable with those of customary modes of NO administration. At low (450 ml) and ultra-low (230 ml) tidal volumes, pulsed delivery yielded better agreement of the set target (up to 40 ppm) and inspiratory NO concentrations as compared to customary modes. Pulsed delivery with NO injection close to the artificial lung yielded higher intrapulmonary NO concentrations than with NO injection close to the ventilator. The maximum inspiratory NO concentration observed in the trachea (68 +/- 30 ppm) occurred with pulsed delivery at a set target of 40 ppm. Conclusion: Pulsed early inspiratory phase NO injection is as effective as continuous or non-selective admixture of NO to inspired gas and may confer improved target reliability, especially at low, lung protective tidal volumes