Das Beziehungsdreieck von Klient, Beiständin und Kindes- und Erwachsenenschutzbehörde (KESB): Erleben und Handlungsstrategien der involvierten Akteure

In vorliegender Bachelorthesis geht es um das Beziehungsdreieck Klient-Beiständin-KESB. Das Ziel ist es herauszufinden, wie dieselbe Situation von den verschiedenen Beteiligten interpretiert wird und welche Strategien in der Zusammenarbeit angewendet werden. Da das Erwachsenenschutzrecht die Grundlage für die Arbeit der Beiständin und der KESB ist, wurden die wichtigsten Gesetzesartikel in Bezug zur Forschungsfrage erläutert. Auch die Selbstbestimmung der Klienten nimmt im neuen Erwachsenenschutzrecht einen grossen Stellenwert ein, weshalb auch diese thematisiert wurde. Im Theorieteil erfolgte die Auseinandersetzung mit der Sozialarbeit im Zwangskontext, dem Berufskodex der Sozialen Arbeit und der Interaktion im Dreieck Klient-Beiständin-KESB. Um die Forschungsfrage zu beantworten, wurden vier narrative Interviews geführt: je eines mit zwei Klienten, die eine Vertretungsbeistandschaft mit Vermögensverwaltung ohne Einschränkung der Handlungsfähigkeit nach ZGB Art. 394 und 395 haben, sowie eines mit der Beiständin und eines mit einer KESB-Präsidentin. Aus den Interviews ging hervor, dass die Situationsdeutung vor allem dann auseinander geht, wenn Zwang oder Druck zu Grunde liegt. Je nach Interpretation einer Situation, wenden die Beteiligten verschiedene Strategien an, um darauf zu reagieren. Alle haben gemeinsam, dass sie sich als Akteure behaupten und dabei ihre Handlungsfähigkeit unter Beweis stellen wollen, wenn diese bedroht scheint

Is hemifacial spasm accompanied by hemodynamic changes detectable by ultrasound?

Background: Arterial tortuosity of the posterior circulation compressing the facial nerve induces the ephaptic axono-axonal cross-talk that sparks hemifacial spasm. We sought if a noninvasive method such as color duplex of these arteries might detect hemodynamical changes in this condition. Methods: Nine patients with hemifacial spasm, successfully treated with botulinum toxin, were examined with color-coded duplex ultrasound. Mean blood flow velocities of the vertebral, basilar, posterior inferior cerebellar, and anterior inferior cerebellar arteries were measured and side-to-side comparison performed. Results: In all nine patients, the mean blood flow velocity, averaging across the two arteries, was higher on the side of the hemifacial spasm (Fisher's exact p < 0.008; two-tailed). The results of the repeated measures ANOVA show that the main effect of side of flow was statistically significant, F(1,8) = 17.354, p = .0032, with higher mean blood flow velocities observed on the side of the hemifacial spasm. There was no significant association between the mean flow velocity of the vertebral artery and the side of spasm (p = 0.523). Conclusions: Hemifacial spasm also seems to relate to hemodynamic changes, which may be detectable by color duplex imaging

Microbubble potentiated transcranial duplex ultrasound enhances IV thrombolysis in acute stroke

Background: We studied whether 2MHz transcranial color-coded duplex ultrasound (TCCD), combined with a second generation ECA, accelerate IV rtPA-thrombolysis in the acute phase of MCA stroke more than TCCD monitoring alone. Methods: Non-randomized acute MCA stroke patients undergoing IV rtPA-thrombolysis and 2MHZ-TCCD monitoring over 60min, with (N=11) or without (N=15) additional continuous ECA (5ml, SonoVue®) perfusion, were compared. Recanalization of the MCA was measured pre- and post-thrombolysis with the thrombolysis in brain ischemia (TIBI) grading system, clinical outcome was assessed at admission and 24h after treatment using the NIH stroke scale (NIHSS). Results: Patients who received ECA improved their NIHSS significantly more than those who were only TCCD monitored (Mann-Whitney U=48.0; P=0.050), and their flow signal improved more (Mann-Whitney U=40.0; P<0.03). Conclusions: The results of this pilot study show that in IV-thrombolysis the use of ECA in addition to TCCD monitoring lead to a greater immediate clinical improvement and to a better flow signa

Preclinical testing of a new clot-retrieving wire device using polyvinyl alcohol hydrogel vascular models

Introduction: Cerebral embolism is the principal cause of cerebral infarction. Recently, mechanical embolectomy has been proposed as an effective method. We performed a preclinical evaluation of a new mechanical clot-retrieving wire. Methods: This clot-retrieving wire consisted of three nitinol loops at the tip of a microguidewire. These three loops could be collapsed into a 0.018-inch wire compatible microcatheter. Each loop was 8mm long and 3.5mm wide. For simulation, polyvinyl alcohol (PVA) vascular anatomical models of the human carotid (eight models) and vertebrobasilar (three models) circulation were constructed. A pulsatile flow circulation system was used. Embolic clots were produced using pig blood plasma. The microcatheter and the microguidewire were advanced beyond the clot. The wire was then exchanged for the retrieving wire. The microcatheter was then pulled slightly back to open the loops. The clot was then caught by withdrawal of the system. Once caught, the clot was retrieved to the guiding catheter tip. We investigated the following points: ease of device deployment, clot capture ability, clot removal against blood flow and removal of the clot out of the introducer system. Results: A total of 104 procedures were performed in 11 PVA models and evaluated. The drop rate was 19%. We succeeded in partial and total recanalization in 51.0% of the procedures (53/104) within 30minutes. Conclusion: This new clot-retrieving wire could be useful for mechanical clot extraction in strok

Is hemifacial spasm accompanied by hemodynamic changes detectable by ultrasound?

Arterial tortuosity of the posterior circulation compressing the facial nerve induces the ephaptic axono-axonal cross-talk that sparks hemifacial spasm. We sought if a noninvasive method such as color duplex of these arteries might detect hemodynamical changes in this condition

Focal common carotid artery intramural hematoma

Isolated focal common carotid artery dissection is a rare condition

Dissections carotidiennes et vertébrales spontanées

Dissections of the cervical arteries account for approximately 15-20 % of all strokes in young patients. Clinically they present with laterocervical and/or hemicranial pain associated to a Horner syndrome in case of carotid dissection and a posterior cervical pain associated to headache in the occipital area in case of vertebral dissection. A multifactorial origin is often suggested, resulting from the combination of a weakness of the arterial wall, hereditary or not, of environmental factors such minor trauma or a previous infection and also of the presence of a certain number of vascular risk factors such as high blood pressure or migraines. The diagnosis is best established with MRI which shows specifically the intramural hematoma. Treatment includes anticoagulants or antiplatelets agents

Transforaminal Doppler: an alternative to transtemporal approach for right-to-left cardiac shunt assessment

BACKGROUND: Paradoxical thrombotic embolism via right-to-left shunt is a risk factor for ischemic stroke, especially in younger subjects. Transtemporal Doppler shows a sensibility and specificity in the detection of patent foramen ovale comparable to that of transesophageal echocardiography, but even younger patients may not have a sufficient acoustic temporal bone window (up to 10%). METHODS AND RESULTS: We thus studied prospectively in 74 patients subsequent to a recent stroke of undetermined origin whether transforaminal (foramen magnum) Doppler is an alternative to transtemporal Doppler in the detection and quantification of right-to-left cardiac shunt. We found a highly significant correlation between the two methods. CONCLUSIONS: We conclude that transforaminal Doppler may be a complement and alternative to transtemporal Doppler and thus improve its value as a screening method for right-to-left cardiac shunt due to patent foramen ovale