Qualitätsentwicklung der Nierentransplantation am Universitätsklinikum Homburg/ Saar : Die Anastomosenzeit und die Komplikationsrate als Lernkurvenparameter im Rahmen der Nierentransplantation an einem urologischen Zentrum – Kunst kommt von üben… : „Old-for-old“-Programm Ergebnisse am Universitätsklinikum Homburg/ Saar

Eine terminale Niereninsuffizienz kann kurativ nur durch eine Nierentransplantation therapiert werden. Hingegen ist die Dialyse eine nicht kurative Therapie. Der Organmangel stellt sich als zentrales Problem der Transplantationsmedizin dar. Ein weiteres Problem ist die Altersstruktur der Organspender und die zunehmende Ko-Morbidität der Organempfänger. Dadurch hat der Transplanteur eine hohe Verantwortung und muss ein suffizientes operatives Training und aus-reichende Erfahrungen haben, um eine Nierentransplantation erfolgreich durchzuführen. Das Ziel dieser retrospektiven Studie, die auf Grundlage einer prospektiv angelegten Datenbank durchgeführt wurde, ist herauszufinden, in welchem Maß die chirurgischen Komplikationen und die funktionellen Ergebnisse nach einer Nierentransplantation von den Erfahrungen der einzelnen Transplanteure abhängig sind. Mit den Ergebnissen soll eine Lernkurve für Nierentransplantatio-nen erstellt und eine Grundlage für die Entwicklung strukturierter Ausbildungsprogramme gebildet werden. Um unter anderem einen langfristigen Operationserfolg darzustellen, werden auch die Überlebenskurven der Patienten und die Funktionsanalysen der Transplantate ausgewertet. Gesondert betrachtet werden im Rahmen dieser Studie das Langzeitüberleben der Transplantate und der Patienten, die im „Old-for-old“-Programm transplantiert wurden. Die Ergebnisse der vorliegenden Studie zeigen, dass das Langzeitüberleben der Patienten und die Wahrscheinlichkeit für das Auftreten von chirurgischen Komplikationen von den Erfahrungen des Transplanteurs abhängig ist. Die Erfahrungen der Transplanteure haben Einfluss auf die Länge der Ischämiezeiten. Bezüglich der Komplikationen kann ein Zusammenhang insbesondere bei Harnleiterfisteln und Lymphozelen sowie die Wahrscheinlichkeit für die Notwendigkeit einer Ballondilatation der arteriellen Gefäßanastomose im weiteren postoperativen Verlauf gezeigt werden. Hingegen haben die Erfahrungen der Transplanteure keinen direkten Einfluss auf die Entwicklung einer verzögerten Funktionsaufnahme des Transplantates (DGF) und auf das Transplantatüberleben. Einen Einfluss haben die operativen Erfahrungen der Transplanteure dennoch auf das Patientenüberleben. Dezidierte Ausbildungsprogramme könnten zukünftig einen Fokus auf die gefäßchirurgischen Techniken zur Vermeidung von Anastomosenengen und auf Ureterimplantationsmethoden legen. Zudem sollten Techniken zur Verringerung von Lymphozelen untersucht werden. Perspektivisch ist nur durch die Steigerung der Operations-Fallzahlen eine effiziente Ausbildung möglich, da nur so ein Mindestmaß an 40 Prozeduren in einer überschaubaren Zeitspanne für die Ausbildung erreicht werden kann. Zusätzlich sollte das „Old-for-old“-Programm weiter ausgebaut werden, denn grade die älteren Nierenempfänger profitieren von einer Nierentransplantation.Quality development of kidney transplants at the University Hospital Homburg / Saar: The anastomotic time and the complication rate as learning curve parameters in the con-text of kidney transplantation at a urological center - art comes from practicing ... "Old-for-old" program results at the University Hospital Homburg / Saar Terminal renal failure can only be treated curatively with a kidney transplant. In contrast, dialysis is a non-curative therapy. The lack of organs is a central problem in transplant medicine. Another problem is the age structure of organ donation and the increasing co-morbidity of organ recipi-ents. As a result, the transplant surgeon has a high level of responsibility and must have sufficient operative training and sufficient experience in order to perform a kidney transplant successfully. The aim of this retrospective study, which was performed on the basis of a prospectively created database, is to find out to what extent the surgical complications and functional results after a kidney transplant depend on the experience of the individual transplant surgeons. The results are intended to create a learning curve for kidney transplants and form a basis for the development of structured training programs. In order to show, among other things, a long-term success of the operation, the survival curves of the patients and the functional analyzes of the transplants are also evaluated. The long-term survival results of the transplants and the patients who were transplanted in the “old-for-old” program is considered separately in this study. The results of the present study show that the patient's long-term survival and the likelihood of surgical complications depend on the experience of the transplant surgeon. The experience of the transplant surgeon influences the length of the ischemia times. With regard to the complica-tions, a connection is shown especially with ureteral fistulas and lymphoceles as well as the likeli-hood of the need for balloon dilatation of the arterial vascular anastomosis in the further postop-erative process. On the other hand, the experiences of the transplant surgeons have no direct influence on the development of delayed graft function (DGF) and on transplant survival. How-ever, the surgical experience of the transplant surgeons has an influence on patient survival. Dedicated training programs should have a focus in future on vascular surgical techniques to avoid anastomotic narrowing and ureter implantation methods. Techniques to reduce lympho-celes should also be explored. In the long term, efficient training is only possible by increasing the number of surgical cases, so the transplant surgeon can achieve a minimum of 40 procedures in a manageable period of time for training. In addition, the “old-for-old” program should be expand-ed, because it is the older kidney recipients who benefit from a kidney transplant

Racial-Ethnic Socialization: Korean American Mothers\u27 Perspectives and Messages on Racism and Discrimination

The purpose of this qualitative study was to explore Korean American mothers’ perspectives and messages on racism and discrimination, and the ways racial-ethnic socialization unfolds in families’ daily lives. Participants were 17 Korean American mothers to either monoracial or biracial Korean American children. Data were collected through semi-structured interviews. Six themes were drawn from the interviews using phenomenological methods: (1) experiences with racism and discrimination; (2) messages on racism and discrimination; (3) messages on racial- ethnic identity; (4) same racial-ethnic friendship vs. cross racial-ethnic friendship; (5) emotions that drive mothers’ decisions on racial-ethnic socialization; and (6) coping with racism and discrimination. These six themes were analyzed based on four different racial-ethnic socialization styles. The findings indicated that (1) mothers who engaged in protective socialization demonstrated a great deal of social awareness and interest in empowering their children to understand and cope with racism; (2) mothers who engaged in promotive integration socialization promoted Korean heritage and American identity, but downplayed racism; (3) mothers who engaged in promotive separation socialization emphasized Korean cultural values, while denying their U.S. born children’s American identity; (4) a mother who engaged in passive socialization denied her child’s experience with racism and newly emerging racial-ethnic identity, resulting in conflicts with her child

Look in the past to dress for the future

The relationship between nostalgic associations and fundamental developments in design: lines and construction in commercial sportswearProgram: Master Programme in Fashion and Textile Desig

MaTech - Neue Materialien fuer die innovative Fertigung. Mikrobearbeitete und veredelte Hochtemperaturwerkstoffe fuer Werkzeuge zur Heissformgebung von Spezialglaesern Schlussbericht

SIGLEAvailable from TIB Hannover: F03B383 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung und Forschung (BMBF), Bonn (Germany)DEGerman

Konzeption eines Shuttle-SAR fuer die Planungsstudie der DFVLR Abschlussbericht. Abschlussdatum: Juli 1984

SIGLETIB: AC 8184 / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekDEGerman

Konzeption eines Shuttle-SAR fuer die Planungsstudie der DFVLR Abschlussbericht

Done in order of Bundesministerium fuer Forschung und Technologie (BMFT), Bonn. Doc.no. ERYS-019/84Available from: Dornier System G.m.b.H., Friedrichshafen (Germany, F.R.) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

Mikrostrukturelle Charakterisierung von Hochtemperaturglasloten Abschlussbericht zum Qualifizierungsprojekt (Verbund)

High-temperature resistant ceramic joints on a solder glass basis are investigated by a few research institutions but there are no commercial activities in spite of the demand for such joining techniques. Potential users are given important information through presentation of the results of technological investigations into solder glass ceramics joining at temperatures >800 C, the characterization of technical joint parameters, and the description of microstructural changes at high temperatures. Fuel cell and sensor production are among the conceivable uses. (orig.)SIGLEAvailable from TIB Hannover: F94B1560+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Entwicklung der Methode der atmosphaerischen Rasterelektronenmikroskopie in der archaeologischen Forschung am Beispiel der Fundstuecke aus dem 'Fuerstengrab' von Gommern Schlussbericht

SIGLEAvailable from TIB Hannover: RR 633(1995,9)+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman

Multi-national survey on the methods, efficacy, and safety on the post-approval clinical use of pulsed field ablation (MANIFEST-PF)

Aims Pulsed field ablation (PFA) is a novel atrial fibrillation (AF) ablation modality that has demonstrated preferential tissue ablation, including no oesophageal damage, in first-in-human clinical trials. In the MANIFEST-PF survey, we investigated the 'real world' performance of the only approved PFA catheter, including acute effectiveness and safety-in particular, rare oesophageal effects and other unforeseen PFA-related complications. Methods and results This retrospective survey included all 24 clinical centres using the pentaspline PFA catheter after regulatory approval. Institution-level data were obtained on patient characteristics, procedure parameters, acute efficacy, and adverse events. With an average of 73 patients treated per centre (range 7-291), full cohort included 1758 patients: mean age 61.6 years (range 19-92), female 34%, first-time ablation 94%, paroxysmal/persistent AF 58/35%. Most procedures employed deep sedation without intubation (82.1%), and 15.1% were discharged same day. Pulmonary vein isolation (PVI) was successful in 99.9% (range 98.9-100%). Procedure time was 65 min (38-215). There were no oesophageal complications or phrenic nerve injuries persisting past hospital discharge. Major complications (1.6%) were pericardial tamponade (0.97%) and stroke (0.4%); one stroke resulted in death (0.06%). Minor complications (3.9%) were primarily vascular (3.3%), but also included transient phrenic nerve paresis (0.46%), and TIA (0.11%). Rare complications included coronary artery spasm, haemoptysis, and dry cough persistent for 6 weeks (0.06% each). Conclusion In a large cohort of unselected patients, PFA was efficacious for PVI, and expressed a safety profile consistent with preferential tissue ablation. However, the frequency of 'generic' catheter complications (tamponade, stroke) underscores the need for improvement