Schemaanalyse und Funktionsanalyse in der Verhaltensdiagnostik: Eine empirische Studie zu Überlebensregel und Reaktionskette zum Symptom

Bei den Patienten einer Therapiestudie wurde eine Schemaanalyse zur Identifizierung der impliziten dysfunktionalen Überlebensregel durchgeführt, die inhaltsanalytisch untersucht wurde. Zudem wurde mit einer Funktionsanalyse die individuelle Reaktionskette bis zur Symptombildung erarbeitet und diese ebenfalls inhaltsanalytisch untersucht. Die Verbindung von Schema- und Funktionsanalyse zu einem individuellen Störungsmodell ergab einen hohen Erklärungswert. Die Reaktionskette wird wesentlich durch die Überlebensregel gesteuert. Der primäre Handlungsimpuls in der symptomauslösenden Situation verstößt gegen die individuelle Überlebensregel, wird unterdrückt, und stattdessen erfolgt eine Handlung, die die Überlebensregel erlaubt. Die gezielte therapeutische Änderung der Überlebensregel und ihres Einflusses auf Erleben und Verhalten war möglich. Es liegen sehr gute Effektstärken vor

Continued non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists during transcatheter aortic valve implantation

BACKGROUND One-third of patients undergoing transcatheter aortic valve implantation (TAVI) have an indication for long-term oral anticoagulation (OAC). AIMS We aimed to investigate whether continued non-vitamin K antagonist oral anticoagulant (NOAC) therapy compared with continued vitamin K antagonist (VKA) therapy during TAVI is equally safe and effective.  Methods: Consecutive patients on OAC with either NOAC or VKA undergoing transfemoral TAVI at five European centres were enrolled. The primary outcome measure was a composite of major/life-threatening bleeding, stroke, and all-cause mortality at 30 days. RESULTS In total, 584 patients underwent TAVI under continued OAC with 294 (50.3%) patients receiving VKA and 290 (49.7%) patients receiving NOAC. At 30 days, the composite primary outcome had occurred in 51 (17.3%) versus 36 (12.4%) patients with continued VKA and with continued NOAC, respectively (odds ratio [OR] 0.68, 95% confidence interval [CI]: 0.43-1.07; p=0.092). Rates of major/life-threatening bleeding (OR 0.87, 95% CI: 0.52-1.47; p=0.606) and stroke (OR 1.02, 95% CI: 0.29-3.59; p=0.974) were not different between groups. In a multivariate Cox regression analysis, continued NOAC, compared with continued VKA, was associated with a lower risk for all-cause 1-year mortality (hazard ratio [HR] 0.61, 95% CI: 0.37-0.98; p=0.043). The analysis of the propensity score-matched cohort revealed similar results. CONCLUSIONS Continued NOAC compared with continued VKA during TAVI led to comparable outcomes with regard to the composite outcome measure indicating that continued OAC with both drugs is feasible. These hypothesis-generating results need to be confirmed by a dedicated randomised controlled trial

Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Vitamin K Antagonists or Direct Oral Anticoagulants.

OBJECTIVES The authors investigated whether transcatheter aortic valve replacement (TAVR) with periprocedural continuation of oral anticoagulation is equally safe and efficacious as TAVR with periprocedural interruption of anticoagulation. BACKGROUND A significant proportion of patients undergoing TAVR have an indication for long-term oral anticoagulation. The optimal periprocedural management of such patients is unknown. METHODS Consecutive patients on oral anticoagulation who underwent transfemoral TAVR at 5 European centers were enrolled. Oral anticoagulation was either stopped 2 to 4 days before TAVR or continued throughout the procedure. Primary safety outcome was major bleeding. Secondary efficacy endpoints included vascular complications, stroke, and mortality. RESULTS Of 4,459 patients, 584 patients were treated with continuation of anticoagulation and 733 with interruption of anticoagulation. At 30 days, major or life-threatening bleedings occurred in 66 (11.3%) versus 105 (14.3%; odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.61 to 1.21; p = 0.39) and major vascular complications in 64 (11.0%) versus 90 (12.3%; OR: 0.89, CI: 0.62 to 1.27; p = 0.52) of patients with continuation and with interruption of anticoagulation, respectively. Transfusion of packed red blood cells was less often required in patients with continuation of anticoagulation (80 [13.7%] vs. 130 [17.7%]; OR: 0.59, 95% CI: 0.42 to 0.81; p = 0.001). Kaplan-Meier estimates of survival at 12 months were 85.3% in patients with continuation of anticoagulation and 84.0% in patients with interruption of anticoagulation (hazard ratio: 0.90, 95% CI: 0.73 to 1.12; p = 0.36). CONCLUSIONS Continuation of oral anticoagulation throughout TAVR did not increase bleeding or vascular complication rates. Moreover, packed red blood cell transfusions were less often required in patients with continuation of oral anticoagulation

Aquatische Optische Technologien in Deutschland

Optische Technologien und Verfahren sind sowohl in der limnischen als auch marinen Forschung Deutschlands über alle Bereiche und Skalen etabliert und entwickeln sich rasant weiter. Die Arbeitsgruppe „Aquatische Optische Technologien“ (AOT) will Forschern und Anwendern eine Plattform bieten, die Wissenstransfer fördert, der nationalen Entwicklergemeinschaft ein synergistisches Umfeld eröffnet und die internationale Sichtbarkeit der deutschen Aktivitäten in diesem Forschungsfeld erhöht. Diese Zusammenfassung dokumentiert erstmalig die AOT-Verfahren und -Technologien, die von nationalen Forschungsinstitutionen eingesetzt werden. Wir erwarten, dass die Dokumentation einen Trend in Richtung institutsübergreifender Harmonisierung initiiert. Dies wird die Etablierung offener Standards, eine Verbesserung im Zugang zu Dokumentationen und gegenseitige technischer Hilfestellung bei (System-) Integrationen ermöglichen. Effizienz und Leistungsfähigkeit der AOT-Entwicklung und Anwendung auf nationaler Ebene werden von diesen Bestrebungen profitieren. Weitere Arbeitsgruppen und Entwickler werden ausdrücklich ermutigt, Kontakt aufzunehmen, um in einer späteren Auflage berücksichtigt zu werden

Sickle cell disease in Germany: Results from a national registry

Background Limited data on the prevalence and medical care of sickle cell disease (SCD) in Germany are available. Here, we make use of a patient registry to characterize the burden of disease and the treatment modalities for patients with SCD in Germany. Procedure A nationwide German registry for patients with SCD documents basic data on diagnosis and patient history retrospectively at the time of registration. A prospective annual documentation provides more details on complications and treatment of SCD. For the current analyses, data of 439 patients were available. Results Most patients had homozygous SCD (HbSS 75.1%, HbS/beta-thalassemia 13.2%, and HbSC 11.3%). The median age at diagnosis was 1.9 years (interquartile range, 0.6-4.4 years), most patients were diagnosed when characteristic symptoms occurred. Sepsis and stroke had affected 3.2% and 4.2% of patients, respectively. During the first year of observation, 48.3% of patients were admitted to a hospital and 10.1% required intensive care. Prophylactic penicillin was prescribed to 95.6% of patients with homozygous SCD or HbS/beta thalassemia below the age of six and hydroxycarbamide to 90.4% of patients above the age of two years. At least one annual transcranial Doppler ultrasound was documented for 74.8% of patients between 2 and 18 years. Conclusion With an estimated number of at least 2000, the prevalence of SCD in Germany remains low. Prospectively, we expect that the quality of care for children with SCD will be further improved by an earlier diagnosis after the anticipated introduction of a newborn screening program for SCD