Postoperatives Schmerzmanagement in der Pflege

Problem Trotz Verbesserungen in der Schmerzforschung und dem Einsatz von neuen Techniken und Methoden ist es noch immer so, dass PatientInnen nach Operationen aufgrund eines inadäquaten Schmerzmanagements unter unnötigen Schmerzen leiden. Würde man die Erkenntnisse des modernen Schmerzmanagements umsetzen, könnte bei vielen PatientInnen eine Schmerzlinderung oder eine Schmerzfreiheit erzielt werden. Ziel der Arbeit In dieser Arbeit sollen der aktuelle Kenntnisstand des Schmerzerlebens aus Sicht der PatientInnen in Bezug auf Ihre Zufriedenheit mit dem Schmerzmanagement nach Operationen ermittelt werden. Weiteres Ziel ist es herauszufinden, welchen Einfluss und welche Wirksamkeit präoperative Schulungs- und Beratungsmaßnahmen auf die PatientInnen haben. Es soll auch veranschaulicht werden, wie man in einem Krankenhaus einen Expertenstandard zum Thema „Schmerzmanagement in der Pflege“ implementieren kann. Methode Die Beantwortung der Forschungsfragen erfolgte anhand einer systematischen Literaturübersicht und durch Heranziehen des Expertenstandard „Schmerzmanagement in der Pflege bei akuten Schmerzen“, welcher vom Deutschen Netzwerk für Qualitätsentwicklung in der Pflege (DNQP) 2005 entwickelt und 2011 neu evaluiert wurde. Für die systematische Literaturübersicht wurde eine Literaturrecherche im Zeitraum von Oktober 2011 bis Februar 2012 in den Datenbanken CINAHL, Pupmed/Medline und einer Handsuche in Fachzeitschriften der Bibliothek der Universität Wien durchgeführt. Unter Berücksichtigung von bestimmten Ein- und Ausschlusskriterien wurden 22 Studien in diese Arbeit eingeschlossen. Schlussfolgerungen Trotzdem die überwiegende Mehrzahl der PatientInnen mäßige bis starke Schmerzen nach Operationen erlebten, waren sie mit dem Schmerzmanagement zufrieden. Dies unterstreicht, dass die PatientInnen nicht in angemessener Weise über die Möglichkeiten der Schmerzlinderung aufgeklärt sind. Das bei PatientInnen - aber auch Pflegepersonen und ÄrztInnen - weit verbreitete Vorurteil der Zusammengehörigkeit von Operation und Schmerz kann nur durch Aufklärung, Beratung und Schulung aller am Prozess beteiligten Personen zurückgedrängt werden. Präoperative Schulungs- und Beratungsmaßnahmen haben positive Auswirkungen auf die Schmerzwahrnehmung, die Angst und die Selbstpflegekompetenz der PatientInnen und stellen in Ergänzung zur medikamentösen Schmerzbehandlung einen wichtigen Eckpfeiler für die professionelle Pflege dar. Die Implementierung und Umsetzung eines Expertenstandard Schmerzmanagement in der Pflege ist zur Etablierung und Verbesserung des Schmerzmanagements in der Pflege sehr zu empfehlen.Problem Despite improvements in the field of pain research and usage of new procedures and methods patients are still suffering from unnecessary pain after surgery due to inadequate pain management. If the scientific findings of modern pain management were implemented, many patients would be able to benefit from pain relief, or would even be able to get rid of their pain at all. Aims This paper should determine the present knowledge on how patients suffer from pain related to their satisfaction of pain management after surgeries. Furthermore the aim is to find out how preoperative instruction and consultation influence and affect patients. As far as “pain management in nursing” is concerned it should be shown how a standard of expert in a hospital can be implemented. Methods A systematic review of the existing professional literature in the field of pain management as well as a consideration of the standard reference “Pain management in nursing for severe pain” (developed by the German Network for Quality Development in Nursing - DNQP - in 2005, re-evaluated in 2011) were used to find the answers to the research question. From October 2011 - February 2012 literature research was conducted in the data bases CINAHL, Pupmed / Medline as well as in professional journals at the library of the University of Vienna in order to analyse the literature systematically. 22 Studies have been used for this study, taking several criteria and exclusion into account. Conclusions Although the vast majority of patients suffer from moderate to intense pain after surgery, they were satisfied with their pain management. This emphasises that patients are not informed about available opportunities regarding pain relief in an appropriate way. Patients and even nursing staff as well as doctors have the common stereotype that surgery and pain belong together, therefore clarification of facts, advice and instruction are needed for people involved in these procedure. Preoperative instruction and consultation have positive effects on perception of pain, insecurity and self-care responsibility of patients. Therefore they represent an important cornerstone for professional care in addition to medicinal pain treatment. The implementation and realization of a standard of expert on the subject of pain management is highly recommended in order to establish and improve pain management in nursing

Sozialismus und Apokalyptik: Die politische Theologie des „kleinen" Otto Bauer

,,Socialism and Apocalyptic" introduces political theology and the posthumous work of Otto Bauer (1897-1986). Bauer himself was from 1927 to 1934 chairman of the Federation of Religious Socialists (BRS) in Austria. His posthumous writings have been unpublished to date and represent an attempt at a political theology whose theological and philosophical interrelationships depict a specific interpretation of apocalyptic."Sozialismus und Apokalyptik" führt in die politische Theologie und das nachgelassene Werk Otto Bauers (1897-1986) ein. Bauer war von 1927 bis 1934 Obmann des Bundes der Religiösen Sozialisten (BRS) in Österreich. Seine nachgelassenen Schriften sind bis dato unveröffentlicht und stellen den Versuch einer politischen Theologie dar, deren theologische und philosophische Verflechtungen eine spezifische Interpretation von Apokalyptik abbilden

Deletion of the Zinc Transporter Lipoprotein AdcAII Causes Hyperencapsulation of Streptococcus pneumoniae Associated with Distinct Alleles of the Type I Restriction-Modification System.

The capsule is the dominant Streptococcus pneumoniae virulence factor, yet how variation in capsule thickness is regulated is poorly understood. Here, we describe an unexpected relationship between mutation of adcAII, which encodes a zinc uptake lipoprotein, and capsule thickness. Partial deletion of adcAII in three of five capsular serotypes frequently resulted in a mucoid phenotype that biochemical analysis and electron microscopy of the D39 adcAII mutants confirmed was caused by markedly increased capsule thickness. Compared to D39, the hyperencapsulated ΔadcAII mutant strain was more resistant to complement-mediated neutrophil killing and was hypervirulent in mouse models of invasive infection. Transcriptome analysis of D39 and the ΔadcAII mutant identified major differences in transcription of the Sp_0505-0508 locus, which encodes an SpnD39III (ST5556II) type I restriction-modification system and allelic variation of which correlates with capsule thickness. A PCR assay demonstrated close linkage of the SpnD39IIIC and F alleles with the hyperencapsulated ΔadcAII strains. However, transformation of ΔadcAII with fixed SpnD39III alleles associated with normal capsule thickness did not revert the hyperencapsulated phenotype. Half of hyperencapsulated ΔadcAII strains contained the same single nucleotide polymorphism in the capsule locus gene cps2E, which is required for the initiation of capsule synthesis. These results provide further evidence for the importance of the SpnD39III (ST5556II) type I restriction-modification system for modulating capsule thickness and identified an unexpected linkage between capsule thickness and mutation of ΔadcAII Further investigation will be needed to characterize how mutation of adcAII affects SpnD39III (ST5556II) allele dominance and results in the hyperencapsulated phenotype.IMPORTANCE The Streptococcus pneumoniae capsule affects multiple interactions with the host including contributing to colonization and immune evasion. During infection, the capsule thickness varies, but the mechanisms regulating this are poorly understood. We have identified an unsuspected relationship between mutation of adcAII, a gene that encodes a zinc uptake lipoprotein, and capsule thickness. Mutation of adcAII resulted in a striking hyperencapsulated phenotype, increased resistance to complement-mediated neutrophil killing, and increased S. pneumoniae virulence in mouse models of infection. Transcriptome and PCR analysis linked the hyperencapsulated phenotype of the ΔadcAII strain to specific alleles of the SpnD39III (ST5556II) type I restriction-modification system, a system which has previously been shown to affect capsule thickness. Our data provide further evidence for the importance of the SpnD39III (ST5556II) type I restriction-modification system for modulating capsule thickness and identify an unexpected link between capsule thickness and ΔadcAII, further investigation of which could further characterize mechanisms of capsule regulation