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

Company Law and Autonomous Systems: A Blueprint for Lawyers, Entrepreneurs, and Regulators

In discussions of the regulation of autonomous systems, private law — specifically, company law — has been neglected as a potential legal and regulatory interface. As one of us has suggested previously,1 there are several possibilities for the creation of company structures that might provide functional and adaptive legal “housing” for advanced software, various types of artificial intelligence, and other programmatic systems and organizations — phenomena that we refer to here collectively as autonomous systems, for ease of reference. In particular, this prior work introduces the notion that an operating agreement or private entity constitution (such as a corporation’s charter or a partnership’s operating agreement) can adopt, as the acts of a legal entity, the state or actions of arbitrary physical systems. We call this the algorithm-agreement equivalence principle. Given this principle and the present capacities existing forms of legal entities, companies of various kinds can serve as a mechanism through which autonomous systems might engage with the legal system. This paper considers the implications of this possibility from a comparative and international perspective. Our goal is to suggest how, under U.S., German, Swiss and U.K. law, company law might furnish the functional and adaptive legal “housing” for an autonomous system — and, in turn, we aim to inform systems designers, regulators, and others who are interested in, encouraged by, or alarmed at the possibility that an autonomous system may “inhabit” a company and thereby gain some of the incidents of legal personality. We do not aim here to be normative. Instead, the paper lays out a template suggesting how existing laws might provide a potentially unexpected regulatory framework for autonomous systems, and to explore some legal consequences of this possibility. We do suggest that these considerations might spur others to consider the relevant provisions of their own national laws with a view to locating similar legal “spaces” that autonomous systems could “inhabit.

The Swiss Kidney Stone Cohort (SKSC), a longitudinal, multi-centric, observational cohort to study course and causes of kidney stone disease in Switzerland.

Kidney stone disease has a high prevalence worldwide of approximately 10 % of the population and is characterized by a high recurrence rate Kidney stone disease results from a combination of genetic, environmental, and life-style risk factors, and the dissection of these factors is complex. The Swiss Kidney Stone Cohort (SKSC) is an investigator-initiated prospective, multi-centric longitudinal, observational study in patients with kidney stones followed with regular visits over a period of 3 years after inclusion. Ongoing follow-ups by biannual telephone interviews will provide long-term outcome data up to 10 years. SKSC comprises 782 adult patients (age > 18 yrs) with either recurrent stones or a single stone event with at least one risk factor for recurrence. In addition, a control cohort of 207 individuals without kidney stone history and absence of kidney stones on a low-dose CT-scan at enrolment has also been recruited. SKSC includes extensive collections of clinical data, biochemical data in blood and 24 hr urine samples, and genetic data. Biosamples are stored at a dedicated biobank. Information on diet and dietary habits were collected through food frequency questionnaires and standardized recall interviews by trained dieticians with the Globodiet software. SKSC provides an unique opportunity and resource to further study cause and course of kidney disease in a large population with data and samples collected of a homogenous collective of patients throughout the whole Swiss population

Melting of tantalum at high pressure determined by angle dispersive x-ray diffraction in a double-sided laser-heated diamond-anvil cell

The high pressure and high temperature phase diagram of Ta has been studied in a laser-heated diamond-anvil cell (DAC) using x-ray diffraction measurements up to 52 GPa and 3800 K. The melting was observed at nine different pressures, being the melting temperature in good agreement with previous laser-heated DAC experiments, but in contradiction with several theoretical calculations and previous piston-cylinder apparatus experiments. A small slope for the melting curve of Ta is estimated (dTm/dP = 24 K/GPa at 1 bar) and a possible explanation for this behaviour is given. Finally, a P-V-T equation of states is obtained, being the temperature dependence of the thermal expansion coefficient and the bulk modulus estimated.Comment: 31 pages, 8 figures, to appear in J.Phys.:Cond.Matte

Sozialstaatliche Kürzungspolitik in Deutschland: Nur eine Mär? Eine quantitative Gesetzgebungsanalyse 1974–2014

Quantitative analyses on welfare state dynamics have to cope with the “dependent variable problem”, as studies on social spending reach different conclusions than analyses of replacement rate data. This article suggests a way around this problem by presenting results from a fine-grained analysis of welfare state legislation in Germany between 1974 and 2014. We show that the German welfare state has seen both cuts and expansions occur in all decades. Moreover, we show by means of a regression analysis that partisan politics play a role. Supporting the “Nixon-in-China”-thesis, social democratic governments are associated with a higher probability of cutbacks – especially in times of budgetary pressure – whereas expansions are more likely under Christian democratic governments

Contested world order: The delegitimation of international governance

This article argues that the chief challenge to international governance is an emerging political cleavage, which pits nationalists against immigration, free trade, and international authority. While those on the radical left contest international governance for its limits, nationalists reject it in principle. A wide-ranging cultural and economic reaction has reshaped political conflict in Europe and the United States and is putting into question the legitimacy of the rule of law among states

Kolonmassage bei Obstipation im palliativen Setting – eine wirksame Intervention?

Hintergrund: Obstipation wird definiert als eine Verringerung der normalen Faeces-Ausscheidungsfrequenz. Sie zählt mit durchschnittlich 50% Prävalenz zu einem der häufigeren Symptome in der Palliative Care. Ziel: Das Poster beschreibt die Wirksamkeit bzw. den Effekt der Kolonmassage bei palliativen Patientinnen und Patienten. Zudem stellt es die Intervention sowie deren Umsetzung im Praxisalltag dar. Methode: Es wurde eine systematisierte Datenbankrecherche auf PubMed und CINAHL durchgeführt. Resultate: Die Kolonmassage kann die Darmperistaltik stimulieren und somit auch die Häufigkeit der Defäkation erhöhen. Zudem können abdominale Schmerzen reduziert werden. Die Intervention wird in einzelnen Schritten detailliert beschrieben. Schlussfolgerung: Die Kolonmassage ist eine von Patientinnen und Patienten als angenehm beschriebene nicht-medikamentöse Intervention bei Obstipation im palliativen Setting, welche ergänzend zur medikamentösen Therapie angewendet werden kann