Akutpsychiatrie ohne Zwang : Prävention von Zwangsmassnahmen bei Kindern und Adoleszenten in der Akutpsychiatrie

Hintergrund : Die Anwendung von Zwangsmassnahmen kann zu psychischen Problemen führen. Kinder und Adoleszente entwickeln im Zusammenhang mit erlebten Zwangsmassnahmen unter anderem vermehrt Albträume, intrusive Gedanken sowie Schreck- und Vermeidungsreaktionen (Magnowski & Cleveland, 2020). Von besonderer Bedeutung sind daher zukünftige Bemühungen, die Anwendung von Zwangsmassnahmen in diesem vulnerablen Alter auf ein Minimum zu reduzieren. Fragestellung : Welche Pflegeinterventionen können zur Prävention von Zwangsmassnahmen bei Kindern und adoleszenten Patient:innen in der Psychiatrie eingesetzt werden? Methode : Um geeignete Studien zur Beantwortung der Forschungsfrage zu finden, haben die Autorinnen eine systematisierte Literaturrecherche durchgeführt. Die Literaturrecherche wurde in zwei Datenbanken durchgeführt. Insgesamt wurden sieben Studien in die Bachelorarbeit inkludiert. Ergebnisse : Die Arten der Interventionen, die sich aus den inkludierten Studien ergeben, lassen sich in zwei Hauptkategorien einteilen: in die der Organisationsentwicklung und die der pflegerischen Interventionen. In beiden Bereichen zeigen sich Erfolge in der Prävention von Zwangsmassnahmen. In einigen Studien konnte demnach die Anzahl der durchgeführten Zwangsmassnahmen signifikant reduziert werden. Schlussfolgerung : Es konnten verschiedene pflegerische Interventionen sowie Interventionen der Organisationsentwicklung identifiziert werden, die zur Reduktion von Zwangsmassnahmen beitragen können. In allen inkludierten Studien wird zudem weiterer Forschungsbedarf beschrieben, da die aktuellen Ergebnisse noch keine Evidenz erreichen

Mesoporosity in Photocatalytically Active Oxynitride Single Crystals

International audienc

Mesoporosity in Photocatalytically Active Oxynitride Single Crystals

Mesoporosity in photocatalytically active oxynitride single crystals and single-crystalline zones has been investigated by transmission electron microscopy techniques including nanobeam diffraction, electron energy loss spectroscopy, electron tomography, and high-resolution imaging. Several particle morphologies of the perovskite-related oxynitride LaTiO₂N were synthesized by solid-state and polymer complex synthesis of the La₂Ti₂O₇ precursor followed by thermal ammonolysis. A detailed analysis of pore sizes, pore shapes, and lattice defects and the local analysis of oxidation states allowed correlation between morphology, synthesis procedures, chemical and crystal defects, and photocatalytic activity. A pore formation mechanism via lattice condensation is proposed, which is simultaneously linked to lattice defect formation processes. On the basis of mechanistic understanding of the transformation from oxide to oxynitride, mesoporosity, and hence the photocatalytic or photoelectrochemical properties of the material, can be tuned

Real space crystallography of a complex metallic alloy: high-angle annular dark-field scanning transmission electron microscopy of o-Al4(Cr,Fe)

ISSN:0021-8898ISSN:1600-576

Partial pancreatoduodenectomy versus duodenum-preserving pancreatic head resection in chronic pancreatitis: the multicentre, randomised, controlled, double-blind ChroPac trial

Background There is substantial uncertainty regarding the optimal surgical treatment for chronic pancreatitis. Short-term outcomes have been found to be better after duodenum-preserving pancreatic head resection (DPPHR) than after partial pancreatoduodenectomy. Therefore, we designed the multicentre ChroPac trial to investigate the long-term outcomes of patients with chronic pancreatitis within 24 months after surgery. Methods This randomised, controlled, double-blind, parallel-group, superiority trial was done in 18 hospitals across Europe. Patients with chronic pancreatitis who were planned for elective surgical treatment were randomly assigned to DPPHR or partial pancreatoduodenectomy with a central web-based randomisation tool. The primary endpoint was mean quality of life within 24 months after surgery, measured with the physical functioning scale of the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire. Primary analysis included all patients who underwent one of the assigned procedures; safety analysis included all patients who underwent surgical intervention (categorised into groups as treated). Patients and outcome assessors were masked to group assignment. The trial was registered, ISRCTN38973832. Recruitment was completed on Sept 3, 2013. Findings Between Sept 10, 2009, and Sept 3, 2013, 250 patients were randomly assigned to DPPHR (n=125) or partial pancreatoduodenectomy (n=125), of whom 226 patients (115 in the DPPHR group and 111 in the partial pancreatoduodenectomy group) were analysed. No difference in quality of life was seen between the groups within 24 months after surgery (75.3 [SD 16.4] for partial pancreatoduodenectomy vs 73.0 [16.4] for DPPHR; mean difference -2.3, 95% CI -6.6 to 2.0; p=0.284). The incidence and severity of serious adverse events did not differ between the groups. 70 (64%) of 109 patients in the DPPHR group and 61 (52%) of 117 patients in the partial pancreatoduodenectomy group had at least one serious adverse event, with the most common being reoperations (for reasons other than chronic pancreatitis), gastrointestinal problems, and other surgical morbidity. Interpretation No differences in quality of life after surgery for chronic pancreatitis were seen between the interventions. Results from single-centre trials showing superiority for DPPHR were not confirmed in the multicentre setting

Cardiac assessment and inflammatory markers in children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV2 (PIMS-TS) treated with methylprednisolone versus intravenous immunoglobulins: 6-month follow-up outcomes of the randomised controlled Swissped RECOVERY trialResearch in context

Summary: Background: Previous findings from the Swissped RECOVERY trial showed that patients with Pediatric Inflammatory Multisystem Syndrome–Temporally Associated with SARS-CoV-2 (PIMS-TS) who were randomly assigned to intravenous immunoglobulins or methylprednisolone have a comparable length of hospital stay. Here, we report the 6-month follow-up outcomes of cardiac pathologies and normalisation of clinical or laboratory signs of inflammation from this study population. Methods: This pre-planned follow-up of patients with PIMS-TS included the Swissped RECOVERY Trial reports on the 6-month outcomes of the cohort after randomisation, with a focus on cardiac, haematological, and biochemical findings. The trial was an investigator-initiated randomised multicentre open-label two-arm trial in children and adolescents hospitalised with PIMS-TS at ten hospitals in Switzerland. Cardiological assessments and laboratory analyses were prospectively collected in the intention-to-treat analysis on pre-defined intervals after hospital discharge. Differences between randomised arms were investigated using Chi-square test for categorical and Wilcoxon test for continuous variables. The trial is registered with the Swiss National Clinical Trials Portal (SNCTP000004720) and ClinicalTrials.gov (NCT04826588). Findings: Between May 21, 2021 and April 15, 2022, 75 patients with a median age of 9.1 years (IQR 6.2–12.2) were included in the intention-to-treat population (37 in the methylprednisolone group and 38 in the intravenous immunoglobulin group). During follow-up, the incidence of abnormal left ventricular systolic function, coronary artery aneurysms (CAA), and other signs of inflammation were comparable in both groups. However, we detected cardiac abnormalities with low incidence and a mild degree grade of pathology. CAAs were observed in 2/38 children (5.3%) in the IVIG group and 1/37 children (2.7%) in the methylprednisolone group at 6-month follow-up (difference proportion 0.75; 95% confidence interval (CI) −0.05 to 1.0; p = 0.39). Interpretation: Methylprednisolone alone may be an acceptable first-line treatment as left ventricular systolic dysfunction and clinical/laboratory evidence for inflammation quickly resolved in all children. However, our findings need further confirmation through larger studies as our sample size is likely to be of insufficient power to address rare clinically relevant adverse outcomes. Funding: NOMIS, Vontobel, and Gaydoul Foundation

Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population.

Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2-2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1-2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44-1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5-2.4; smoking: IRR = 2.0, 95% CI = 1.6-2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9-3.8; smoking: IRR = 2.6, 95% CI = 1.9-3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4-2.4; smoking: IRR = 1.7, 95% CI = 1.4-2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity