Experiences of burden, needs, rewards and resilience in family caregivers of people living with Motor Neurone Disease/Amyotrophic Lateral Sclerosis:A secondary thematic analysis of qualitative interviews

Background: Family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, an incurable, mostly rapidly fatal neurodegenerative disease, face many challenges. Although there is considerable research on caregiver burden in Motor Neurone Disease/Amyotrophic Lateral Sclerosis, there is less knowledge of the positive aspects of caring. Objective: To explore the experiences of family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, specifically the relationship between positive and negative experiences of caring, and to identify possible ways to better support these caregivers. Methods: Secondary thematic analysis of 24 semi-structured qualitative interviews conducted longitudinally with 10 family caregivers. Interviews explored rewarding and unrewarding aspects of caring. Results: Themes emerged around burden, needs, rewards and resilience. Resilience included getting active, retaining perspective and living for the moment. Burden was multifaceted, including social burden, responsibility, advocacy, ambivalence, guilt and struggling with acceptance. Rewards included being helped and ‘ticking along’. Needs were multifaceted, including social, practical and psychological needs. The four main themes were interrelated. A model of coping was developed, integrating resilience (active/positive), burden (active/negative), needs (passive/negative) and reward (passive/positive). Conclusion: Burden, resilience, needs and rewards are interrelated. Caregivers’ ability to cope with caring for a person with Motor Neurone Disease/Amyotrophic Lateral Sclerosis oscillates between positive and negative aspects of caring, being at times active, at times passive. Clinical implications: Coping is a non-linear process, oscillating between different states of mind. The proposed model could enable clinicians to better understand the caregiver experience, help family caregivers foster resilience and identify rewards, and develop appropriate individualised caregiver support plans. </jats:sec

Preoperative clonidine blunts hyperadrenergic and hyperdynamic responses to prolonged tourniquet pressure during general anesthesia

Although the mechanism of tourniquet-induced hypertension is still unclear, plasma norepinephrine concentrations continuously increase in parallel to arterial blood pressure during tourniquet inflation. Clonidine attenuates hyperadrenergic and hyperdynamic responses. We investigated the effects of clonidine on prolonged tourniquet inflation. Twenty-nine patients scheduled for elective orthopedic surgery were randomly assigned to receive IV clonidine (3 microg/kg; n = 14) or placebo (n = 15) before tourniquet inflation of the lower limbs under general anesthesia in a double-blinded manner. Arterial blood pressure, heart rate, epinephrine, and norepinephrine plasma concentrations were measured before tourniquet inflation, 60 min after tourniquet inflation, just before tourniquet deflation, and 20 min after tourniquet deflation. Mean arterial blood pressure and norepinephrine plasma-concentrations were significantly lower in the Clonidine group compared with Control after 60 min tourniquet inflation (P = 0.016; P = 0.006). Immediately before deflation of the tourniquet, the difference for mean arterial pressure between groups was even more pronounced (P = 0.005). Twenty minutes after deflation mean arterial blood pressure in the Control group was still increased and significantly higher compared with the Clonidine group (P = 0.002). In conclusion, preoperative IV clonidine blunts hyperadrenergic and hyperdynamic responses resulting from prolonged tourniquet inflation under general anesthesia in ASA class I--II patients. IMPLICATIONS: Tourniquet inflation is associated with a continuous increase in arterial blood pressure and sympathetic outflow. This study shows that IV clonidine effectively blunts increases of both arterial blood pressure and plasma norepinephrine concentrations

Komplikationen nach Schutzimpfungen bei Kindern und Erwachsenen mit Hinweis auf einen kausalen Zusammenhang

Der aktuelle Impfkalender enthält eine Vielzahl von Impfungen, die von der Ständigen Impfkommission (STIKO) für Kinder und Erwachsene zur Grund- und Auffrischimpfung empfohlen werden. Gleichzeitig besteht bei einem Teil der Bevölkerung Impfskepsis (engl. vaccine hesitancy), d.h. die Zögerlichkeit, sich selbst, die eigenen Kinder oder andere Schutzbefohlene impfen zu lassen. Ein Grund dafür ist die Furcht vor Nebenwirkungen. Vor diesem Hintergrund möchten wir im vorliegenden Beitrag auf bekannte Komplikationen nach Schutzimpfungen bei Kindern und Erwachsenen mit Hinweis auf einen kausalen Zusammenhang eingehen