The added value of physiotherapists in preventing pressure injuries in intensive care patients

Physiotherapists improve movement and function for people who experience challenges from aging, injury, illness, or the environment. They promote physical, psychological, emotional and social well-being through prevention, treatment, and rehabilitation (World Physiotherapy, 2023). Intensive care units (ICU) patients frequently struggle with limitations in physical function and activity rendering them at high risk for pressure injuries (PI). The development of PI is augmented by immobility, hypoperfusion, vasopressors, malnutrition, sweating and/or shearing force, whereby the increased pressure on prominent surfaces exceeds the capillary pressure of the underlying tissue resulting in tissue damage and ultimately necrosis (Nieto-García et al., 2021; Pickenbrock et al., 2017). This article discusses how physiotherapists with their specific knowledge can add value to prevent, treat or rehabilitate PI in ICU patients (Fig. 1)

Needs assessment in community-dwelling older adults toward digital interventions to promote physical activity: Cross-sectional survey study

BACKGROUND: Tackling physical inactivity represents a key global public health challenge. Strategies to increase physical activity (PA) are therefore warranted. Despite the rising availability of digital interventions (DIs), which offer tremendous potential for PA promotion, there has been inadequate attention to the special needs of older adults. OBJECTIVE: The aim was to investigate community-dwelling older adults' needs, requirements, and preferences toward DIs to promote PA. METHODS: The target population of this cross-sectional study was community-dwelling older adults (≥60 years old) within German-speaking Switzerland. Potential respondents were informed about the study and sent a link to a self-developed and self-administered online survey by our cooperating institutions. RESULTS: Overall, 922 respondents who completed the online survey were included in the final analysis. The mean age of the sample was 72 years (SD 6.4, range 60-98). The preferred delivery mode of DIs to promote PA was a website (428/922, 46.4%) and 80.3% (740/922) preferred video-based structures. Most respondents expressed the need for personal access, personal goals, personal messages, and a personal contact in case of problems or questions (585/817, 71.6%; 546/811, 67.3%; 536/822, 65.2%; 536/822, 65.2%). Memory training, psychological wellbeing, and nutrition were mainly rated as relevant additional content of DIs to promote PA (690/849, 81.2%; 661/845, 78.2%, 619/849, 72.9%). CONCLUSION: Community-dwelling older adults may be willing to use DIs to promote PA in the long term, but this study identified particular needs and requirements in terms of design, technological realization, delivery mode, support, and individualization/personalization among the sample. Our results can inform future developments of DIs to promote PA specifically tailored to older adults. However, caution is warranted in interpreting the findings due to the sample's high PA and education levels

Interprofessionality in the health professions in the transformation of a modern role and profession development. Report on the results of a world café at the Drei-Länder-Tagung on May 5, 2022 in Bern / Interprofessionalität in den Gesundheitsberufen im Wandel einer modernen Rollen- und Professionsentwicklung. Bericht über die Ergebnisse eines World Cafés auf der Drei-Länder-Tagung am 5. Mai 2022 in Bern

The health professions in the German-speaking region of Germany, Austria and Switzerland, the so-called D-A-CH area, are in dynamic phases of their professionalization due to their shift towards education at universities. In addition, the needs of current and future health care require all health professionals (HPs) to have collaborative competencies and a willingness to work together. This willingness and the challenge of co-creation of health systems by all health professionals is a good starting point for the evolution of the professions. So what must professional profiles, role beliefs - in short, modern professionalization strategies - be like so that, at the beginning of the 21st century, education and professional practice do not remain stuck in old thought structures and templates and in monodisciplinary „silo thinking.” What does it mean in concrete terms for the professionalization of professions that health care professions must (be able to) increasingly work together? Doesn’t professionalization so far tend to mean exclusivity and isn’t a stronger demarcation between the professions then the consequence? Against the background of professionalization through academization, do university studies not tend to aim at a stronger demarcation from other disciplines and professions? Professionalization includes exclusive competencies and specialized methods against the background of one's own profession-related action sciences. At the three-country meeting of the VFWG in Bern on 5–6 May 2022, this area of tension was put up for discussion in a World Café based on four theses. The following article documents the results of the individual discussion rounds and aims to stimulate a critical discours

an interim analysis from the prospective GMMG-MM5 trial

We investigated the impact of subcutaneous versus intravenous bortezomib in the MM5 trial of the German-Speaking Myeloma Multicenter Group which compared bortezomib, doxorubicin, and dexamethasone with bortezomib, cyclophosphamide, and dexamethasone induction therapy in newly diagnosed multiple myeloma. Based on data from relapsed myeloma, the route of administration for bortezomib was changed from intravenous to subcutaneous after 314 of 604 patients had been enrolled. We analyzed 598 patients who received at least one dose of trial medication. Adverse events were reported more frequently in patients treated with intravenous bortezomib (intravenous=65%; subcutaneous=56%, P=0.02). Rates of grade 2 or more peripheral neuropathy were higher in patients treated with intravenous bortezomib during the third cycle (intravenous=8%; subcutaneous=2%, P=0.001). Overall response rates were similar in patients treated intravenously or subcutaneously. The presence of International Staging System stage III disease, renal impairment or adverse cytogenetic abnormalities did not have a negative impact on overall response rates in either group. To our knowledge this is the largest study to present data comparing subcutaneous with intravenous bortezomib in newly diagnosed myeloma. We show better tolerance and similar overall response rates for subcutaneous compared to intravenous bortezomib. The clinical trial is registered at eudract.ema.europa.eu as n. 2010-019173-16

Multidifferential study of identified charged hadron distributions in ZZ-tagged jets in proton-proton collisions at s=\sqrt{s}=13 TeV

Jet fragmentation functions are measured for the first time in proton-proton collisions for charged pions, kaons, and protons within jets recoiling against a $Z$ boson. The charged-hadron distributions are studied longitudinally and transversely to the jet direction for jets with transverse momentum 20 $< p_{\textrm{T}} < 100$ GeV and in the pseudorapidity range $2.5 < \eta < 4$. The data sample was collected with the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 1.64 fb$^{-1}$. Triple differential distributions as a function of the hadron longitudinal momentum fraction, hadron transverse momentum, and jet transverse momentum are also measured for the first time. This helps constrain transverse-momentum-dependent fragmentation functions. Differences in the shapes and magnitudes of the measured distributions for the different hadron species provide insights into the hadronization process for jets predominantly initiated by light quarks.Comment: All figures and tables, along with machine-readable versions and any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-013.html (LHCb public pages

Study of the B−→Λc+Λˉc−K−B^{-} \to \Lambda_{c}^{+} \bar{\Lambda}_{c}^{-} K^{-} decay

The decay $B^{-} \to \Lambda_{c}^{+} \bar{\Lambda}_{c}^{-} K^{-}$ is studied in proton-proton collisions at a center-of-mass energy of $\sqrt{s}=13$ TeV using data corresponding to an integrated luminosity of 5 $\mathrm{fb}^{-1}$ collected by the LHCb experiment. In the $\Lambda_{c}^+ K^{-}$ system, the $\Xi_{c}(2930)^{0}$ state observed at the BaBar and Belle experiments is resolved into two narrower states, $\Xi_{c}(2923)^{0}$ and $\Xi_{c}(2939)^{0}$, whose masses and widths are measured to be $$m(\Xi_{c}(2923)^{0}) = 2924.5 \pm 0.4 \pm 1.1 \,\mathrm{MeV}, \\ m(\Xi_{c}(2939)^{0}) = 2938.5 \pm 0.9 \pm 2.3 \,\mathrm{MeV}, \\ \Gamma(\Xi_{c}(2923)^{0}) = \phantom{000}4.8 \pm 0.9 \pm 1.5 \,\mathrm{MeV},\\ \Gamma(\Xi_{c}(2939)^{0}) = \phantom{00}11.0 \pm 1.9 \pm 7.5 \,\mathrm{MeV},$$ where the first uncertainties are statistical and the second systematic. The results are consistent with a previous LHCb measurement using a prompt $\Lambda_{c}^{+} K^{-}$ sample. Evidence of a new $\Xi_{c}(2880)^{0}$ state is found with a local significance of $3.8\,\sigma$, whose mass and width are measured to be $2881.8 \pm 3.1 \pm 8.5\,\mathrm{MeV}$ and $12.4 \pm 5.3 \pm 5.8 \,\mathrm{MeV}$, respectively. In addition, evidence of a new decay mode $\Xi_{c}(2790)^{0} \to \Lambda_{c}^{+} K^{-}$ is found with a significance of $3.7\,\sigma$. The relative branching fraction of $B^{-} \to \Lambda_{c}^{+} \bar{\Lambda}_{c}^{-} K^{-}$ with respect to the $B^{-} \to D^{+} D^{-} K^{-}$ decay is measured to be $2.36 \pm 0.11 \pm 0.22 \pm 0.25$, where the first uncertainty is statistical, the second systematic and the third originates from the branching fractions of charm hadron decays.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-028.html (LHCb public pages

Measurement of the ratios of branching fractions R(D∗)\mathcal{R}(D^{*}) and R(D0)\mathcal{R}(D^{0})

The ratios of branching fractions $\mathcal{R}(D^{*})\equiv\mathcal{B}(\bar{B}\to D^{*}\tau^{-}\bar{\nu}_{\tau})/\mathcal{B}(\bar{B}\to D^{*}\mu^{-}\bar{\nu}_{\mu})$ and $\mathcal{R}(D^{0})\equiv\mathcal{B}(B^{-}\to D^{0}\tau^{-}\bar{\nu}_{\tau})/\mathcal{B}(B^{-}\to D^{0}\mu^{-}\bar{\nu}_{\mu})$ are measured, assuming isospin symmetry, using a sample of proton-proton collision data corresponding to 3.0 fb${ }^{-1}$ of integrated luminosity recorded by the LHCb experiment during 2011 and 2012. The tau lepton is identified in the decay mode $\tau^{-}\to\mu^{-}\nu_{\tau}\bar{\nu}_{\mu}$. The measured values are $\mathcal{R}(D^{*})=0.281\pm0.018\pm0.024$ and $\mathcal{R}(D^{0})=0.441\pm0.060\pm0.066$, where the first uncertainty is statistical and the second is systematic. The correlation between these measurements is $\rho=-0.43$. Results are consistent with the current average of these quantities and are at a combined 1.9 standard deviations from the predictions based on lepton flavor universality in the Standard Model.Comment: All figures and tables, along with any supplementary material and additional information, are available at https://cern.ch/lhcbproject/Publications/p/LHCb-PAPER-2022-039.html (LHCb public pages

Leitlinienentwurf: "Atmung, Atemunterstützung und Beatmung bei akuter und chronischer Querschnittlähmung"

Fragestellung: Eine Querschnittlähmung (QL) führt häufig zu einer verminderten Atemfunktion. Ursachen sind die lähmungsbedingt verminderte Kraft der in- und exspiratorischen Atemmuskulatur, die veränderte Compliance von Lungen- und Thoraxwand, die gestörte zentrale Atemkontrolle, die Verminderung des Durchmessers und der Reagibilität der Atemwege infolge der autonomen Dysregulation und die veränderte Interaktion zwischen Thorax und Abdomen. Das Ziel der S2k-Leitlinie ist die theoretische Wissensvermittlung in der Behandlung und Betreuung von Menschen mit QL, die einer Atemunterstützung bedürfen. Das praktische Wissen ist mitentscheidend für den Erfolg der Atemunterstützung. Methode: Die Themen der Leitlinie wurden vom Arbeitskreis "BeAtmung" der DMGP festgelegt. Ein Redaktionsteam von 7 Mitgliedern des Arbeitskreises hat die einzelnen Kapitel bearbeitet. In protokollierten Sitzungen des Arbeitskreises seit 2014, sowie durch die mehrmalige Möglichkeit zur schriftlichen Stellungnahme, wurden die Textversionen angepasst. Die letzte Version wurde der DMGP zur Genehmigung vorgelegt und den miteinbezogenen Fachgesellschaften zur Stellungnahme zugestellt und an einer Konsensuskonferenz vom 18.01.2022 diskutiert. Die Leitlinie ist für das Register der Wissenschaftlich Medizinischen Fachgesellschaften angemeldet. Ergebnis: Die Leitlinie fokussiert sich insbesondere auf folgendes Wissen: • Wissen um die QL-spezifischen respiratorischen Probleme mit Berücksichtigung der gestörten muskulären und gastrointestinalen Funktion und deren Auswirkungen auf die Atmung • Wissen um das diagnostische und therapeutische Vorgehen bei temporärer und dauerhafter Beatmungspflicht • Wissen um das diagnostische und therapeutische Vorgehen bezüglich des Husten- und Sekretmanagements • Wissen um das Vorgehen und die Anforderungen bei der Überleitung nach Hause oder in eine in anderer Weise organisierte außerklinische Versorgung • Wissen um die technischen und fachlichen Voraussetzungen in den Behandlungszentren und in der außerklinischen Versorgung bezüglich der Betreuung beatmeter und atmungsunterstützter Menschen mit einer QL • Wissen um die Qualitätssicherung und lebenslange Nachsorge bei der Langzeit-Betreuung, unabhängig von der Art der außerklinischen Versorgung Schlussfolgerung: Die Leitlinie soll dazu beitragen, dass Menschen mit einer verminderten Atemfunktion nach einer QL wissenschaftlich begründet, angemessen, wirtschaftlich und qualitätsgesichert behandelt und betreut werden

Atemtherapie in der Neurologie Das Potential Atemwegskomplikationen nach einer Querschnittlähmung zu reduzieren

Was weiß man bisher? Atemwegskomplikationen nach einer Querschnittlähmung zählen auch heute noch zu der Todesursache Nummer 1. Je höher die Lähmung, desto höher ist die Gefahr von Atemwegskomplikationen. Nach einer Lähmung der inspiratorischen Muskulatur sind tiefe Atemzüge verhindert, die Vitalkapazität und die totale Lungenkapazität sind reduziert, es kann zu Atemnot und Atelektasen kommen. Nach einer Lähmung der exspiratorischen Muskulatur ist der Hustenstoss reduziert und es kommt zu einem Sekretverhalt, der Atemwegswiderstand ist erhöht und die Gefahr von Atemwegsinfektionen steigt an. Einatemtraining ist in der Lage die Kraft der Atemmuskulatur zu stärken. Eine effektive Prophylaxe von Lungenentzündungen benötigt eine sehr hohe Atemmuskelkraft. Was bedeutet das für die Praxis? In der praktischen Behandlung von Patienten nach einer Querschnittlähmung soll Einatemmuskeltraining angewendet werden. Dabei soll ein hoch-intensives Einatemtraining mit wenigen Wiederholungen einem Training mit niedriger Intensität und einem hohen Umfang an Wiederholungen vorgezogen werden. Was erwartet die Teilnehmenden im Seminar? Die Teilnehmenden im Seminar bekommen einen Einblick über potentielle Faktoren, die im Zusammenhang mit einer Lungenentzündung nach einer Querschnittlähmung stehen. Über die modifizierbaren Faktoren lassen sich Inputs für die Behandlung im klinischen Alltag ableiten. Es wird sowohl der theoretische Hintergrund dargestellt, als auch Therapie-Massnahmen praktisch gezeigt. Es wird auf unterschiedliche Therapiemöglichkeiten insbesondere für das Atemmuskeltraining eingegangen