Management von Obstipation im palliativen Setting : Vorschläge für die Umsetzung durch das interprofessionelle Team

Einleitung: Die Palliative Care hat sich zu einem umfassenden Ansatz für die Behandlung von komplexen Symptomen im Spektrum lebenslimitierender Krankheiten entwickelt. Obwohl Obstipation ein häufiges Symptom bei Palliativ-Patient:innen darstellt, scheint bei Health Professionals ein mangelndes Bewusstsein für das Management von Obstipation vorzuliegen. Das Management der Obstipation ist ein multimodaler Ansatz, welcher deren Prävention sowie Behandlung durch Medikation, Flüssigkeits- und Nahrungsaufnahme, Mobilität und Behandlung von obstipationsbedingtem Schmerz beinhaltet (siehe Abb. 1).1 Ziel dieses Managements ist die Wiederherstellung einer aus Patient:innen-Sicht angenehmen Stuhlgewohnheit und die Linderung von Schmerzen, die im Zusammenhang mit Obstipation auftreten können. Fragestellung: Wie kann das interprofessionelle Team das Management von Obstipation im palliativen Setting unterstützen? Methode: In den Datenbanken PubMed und CINAHL Complete wurde eine systematisierte Literaturrecherche durchgeführt. Fünf Studien wurden eingeschlossen. Ergebnisse: Obstipation im palliativen Setting ist aufgrund der veränderten Lebensverhältnisse als ein Langzeitsymptom zu betrachten. Es werden die Interventionen Darm-Massage, Bewegung / Ballaststoffe / Flüssigkeit sowie medikamentöse Interventionen vorgestellt (siehe Tab. 1). Diskussion: Die Interventions-Wahl kann durch fehlende vorherige Durchführung eines geeigneten Assessments sowie Fachwissens-Lücken erschwert sein. Health Professionals sollen Obstipation als interprofessionelle Thematik angehen, wobei auch nicht-medikamentöse Interventionen zum Einsatz kommen sollen. Bedürfnisse und Gewohnheiten der Betroffenen müssen im Management berücksichtigt werden. Schlussfolgerung: Das Symptom Obstipation soll im palliativen Setting im Fokus der Aufmerksamkeit des ganzen interprofessionellen Teams stehen

Fibromatosis of the Plantar Fascia: Diagnosis and Indications For Surgical Treatment

Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection

A Bio-Inspired Swellable Microneedle Adhesive for Mechanical Interlocking with Tissue

Achieving significant adhesion to soft tissues while minimizing tissue damage poses a considerable clinical challenge. Chemical-based adhesives require tissue-specific reactive chemistry, typically inducing a significant inflammatory response. Staples are fraught with limitations including high-localized tissue stress and increased risk of infection, and nerve and blood vessel damage. Here, inspired by the endoparasite Pomphorhynchus laevis which swells its proboscis to attach to its host’s intestinal wall, we have developed a biphasic microneedle array that mechanically interlocks with tissue through swellable microneedle tips, achieving ~ 3.5 fold increase in adhesion strength compared to staples in skin graft fixation, and removal force of ~ 4.5 N/cm2 from intestinal mucosal tissue. Comprising a poly(styrene)-block-poly(acrylic acid) swellable tip and non-swellable polystyrene core, conical microneedles penetrate tissue with minimal insertion force and depth, yet high adhesion strength in their swollen state. Uniquely, this design provides universal soft tissue adhesion with minimal damage, less traumatic removal, reduced risk of infection and delivery of bioactive therapeutics

Analysis of site-specific N-glycan remodeling in the endoplasmic reticulum and the Golgi

The hallmark of N-linked protein glycosylation is the generation of diverse glycan structures in the secretory pathway. Dynamic, non-template-driven processes of N-glycan remodeling in the endoplasmic reticulum and the Golgi provide the cellular setting for structural diversity. We applied newly developed mass spectrometry-based analytics to quantify site-specific N-glycan remodeling of the model protein Pdi1p expressed in insect cells. Molecular dynamics simulation, mutational analysis, kinetic studies of in vitro processing events and glycan flux analysis supported the defining role of the protein in N-glycan processin

Virtual reality rehabilitation system for neuropathic pain and motor dysfunction in spinal cord injury patients

Spinal cord injury (SCI) causes both lower limb motor dysfunction and associated neuropathic pain. Although these two conditions share related cortical mechanisms, different interventions are currently used to treat each condition. With intensive training using entertaining virtual reality (VR) scenarios, it may be possible to reshape cortical networks thereby reducing neuropathic pain and improving motor function. We have created the first VR training system combining action observation and execution addressing lower limb function in incomplete SCI (iSCI) patients. A particular feature of the system is the use of size-adjustable shoes with integrated motion sensors. A pilot single-case clinical study is currently being conducted on six iSCI patients. Two patients tested to date were highly motivated to perform and reported improved physical well-being. They improved in playing skill and in controlling the virtual lower limbs. There were post-intervention indications of neuropathic pain decrease, muscle strength increase, faster walking speed and improved performance on items relevant for ambulation. In addition functional MRI before and after treatment revealed a decreased activation pattern. We interpret this result as an improvement of neuronal synergies for this task. These results suggest that our VR system may be beneficial for both reducing neuropathic pain and improving motor function in iSCI patients

Installation and Hardware commissioning of the Multi-Turn extraction at the CERN proton synchrotron

The implementation of the new Multi-Turn Extraction (MTE) at the CERN Proton Synchrotron required major hardware changes for the nearly 50-year old accelerator. The installation of new Pulse Forming Networks (PFN) and refurbished kicker magnets for the extraction, new sextupole and octupole magnets, new power converters, together with an in-depth review of the machine aperture leading to the design of new vacuum chambers was required. As a result, a heavy programme of interventions had to be scheduled during the winter shut-down 2007-8. The newly installed hardware and its commissioning is presented and discussed in details

Development of SRF Cavity Tuners for CERN

Superconducting RF cavity developments are currently on-going for new accelerator projects at CERN such as HIE ISOLDE and HL-LHC. Mechanical RF tuning systems are required to compensate cavity frequency shifts of the cavities due to temperature, mechanical, pressure and RF effects on the cavity geometry. A rich history and experience is available for such mechanical tuners developed for existing RF cavities. Design constraints in the context of HIE ISOLDE and HL-LHC such as required resolution, space limitation, reliability and maintainability have led to new concepts in the tuning mechanisms. This paper will discuss such new approaches, their performances and planned developments