Lebensqualität und alexithyme Merkmale bei Patienten mit somatoformer Schmerzstörung

Zusammenfassung: Hintergrund: Patienten mit einer somatoformen Schmerzstörung weisen häufig eine schlechte gesundheitsbezogene Lebensqualität (QoL) und Schwierigkeiten in der Affektregulation (Alexithymie) auf. Ziel dieser Studie war es, den Zusammenhang zwischen QoL und alexithymen Merkmalen zu untersuchen. Patienten und Methoden: Bei 51Patienten mit somatoformer Schmerzstörung (durchschnittliche Erkrankungsdauer: 11,6Jahre) wurden Alexithymie (TAS-20), QoL (WHOQOL-BREF), psychische Belastung und Somatisierung (SCL-90-R) und depressive Symptome (MADRS) erhoben. Ergebnisse: Es fand sich eine signifikante negative Korrelation zwischen QoL und alexithymen Persönlichkeitsmerkmalen, insbesondere der psychischen QoL und dem TAS-20-Gesamtwert (r=−0,63, p<0,001). Die Alexithymiesubskala "Schwierigkeiten, Gefühle zu beschreiben" erwies sich als signifikanter Einflussfaktor für die psychische QoL (β=−0,34, p<0,01), auch nach Kontrolle von Depression, Somatisierung und Geschlecht. Schlussfolgerung: Für die insgesamt sehr niedrige QoL von Patienten mit somatoformer Schmerzstörung scheinen auch alexithyme Charakteristika eine wichtige Rolle zu spielen. Dies sollte sowohl diagnostisch als auch in der therapeutischen Zielsetzung berücksichtigt werde

Does access to acute intensive trauma rehabilitation (AITR) programs affect the disposition of brain injury patients?

Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants' demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group's time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6-20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury

Administration of drinking water supplement containing organic acids and medium chain fatty acids to sows significantly reduced incidence of Clostridium-associated diarrhoea in neonatal piglets: a case study

Neonatal diarrhoea in newborn piglets is an important problem in pig production that is frequently diagnosed as being the result of Clostridium perfringens infections. During parturition and in the first hours of life, the sow transmits the pathogen to its offspring. The objective of this study was to examine the possible prophylactic effect of a drinking water supplement containing organic acids and medium chain fatty acids (Selko-4-Health©), administered to sows on prevalence of neonatal diarrhoea in piglets during early lactation. The study was carried out at a farm with 1300 sows with a high incidence of neonatal diarrhoea. Gestating sows received the water supplement (0.1% per litre) daily from day 35 to end of gestation and during the lactation phase for 2 days a week

Timing of major fracture care in polytrauma patients – an update on principles, parameters and strategies for 2020

Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades

Geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone

Purpose: Age in severely injured patients has been increasing for decades. Older age is associated with increasing mortality. However, morbidity and mortality could possibly be reduced when accurate and aggressive treatment is provided. This study investigated age-related morbidity and mortality in polytrauma including age-related decisions in initial injury management and withdrawal of life-sustaining therapy (WLST). Methods: A 6.5-year prospective cohort study included consecutive severely injured trauma patients admitted to a Level-1 Trauma Center ICU. Demographics, data on physiology, resuscitation, MODS/ARDS, and infectious complications were prospectively collected. Patients were divided into age subgroups (< 25, 25–49, 50–69, and ≥ 70 years) to make clinically relevant comparisons. Results: 391 patients (70% males) were included with median ISS of 29 (22–36), 95% sustained blunt injuries. There was no difference in injury severity, resuscitation, urgent surgeries, nor in ventilator days, ICU-LOS, and H-LOS between age groups. Adjusted odds of MODS, ARDS and infectious complications were similar between age groups. 47% of patients ≥ 70 years died, compared to 10–16% in other age groups (P < 0.001). WLST increased with older age, contributing to more than half of deaths ≥ 70 years. TBI was the most common cause of death and decision for treatment withdrawal in all age groups. Conclusions: Patients ≥ 70 years had higher mortality risk even though injury severity and complication rates were similar to other age groups. WLST increased with age with the vast majority due to brain injury. More than half of patients ≥ 70 years survived suggesting geriatric polytrauma patients should not be excluded from aggressive injury treatment based on age alone