Beurteilung der parenteralen Ernährung bei Frühgeborenen unter 1500 g im Universitätsklinikum des Saarlandes im Vergleich zu publizierten Leitlinien

Hintergrund: Ein wichtiger Aspekt für das Wachstum sowie die körperliche Entwicklung von Frühgeborenen ist eine adäquate Nahrungszufuhr. Basierend auf den Ergebnissen zahlreicher Studien werden sowohl die Geschwindigkeit des Nahrungsaufbaus als auch die Substratmengen - insbesondere der parenteralen Nahrung - kontrovers diskutiert. Zielsetzung: Ziel dieser Arbeit war es, das parenterale Ernährungsregime in der Klinik für Allgemeine Pädiatrie und Neonatologie, Homburg bei sehr unreifen Frühgeborenen mit einem Geburtsgewicht < 1500 g zu untersuchen, die zugeführten Substratmengen zu berechnen und mit publizierten Leitlinien zu vergleichen. Methodik: Retrospektive Studie bei very low birthweight Neonaten der neonatologischen Intensivstation des Universitätsklinikums des Saarlandes (Homburg) über einen Zeitraum von zwei Jahren (01.01.2009-31.12.2010). Ergebnisse: In die Studie wurden insgesamt 100 von 120 Frühgeborenen mit einem Geburtsgewicht < 1500 g eingeschlossen. Das mittlere Gestationsalter lag bei 29+4 SSW [Spanne: 24+3-34+1 SSW]. Das Geburtsgewicht aller Frühgeborener lag im Mittel bei 1118,8 g ± 260 g (570 g-1490 g). Bei der Analyse der zugeführten parenteralen und enteralen Nahrungsmengen für Flüssigkeit, Glukose, Aminosäuren, Fette und Energie zeigte sich, dass bis auf die verabreichte Glukosemenge, die geforderten Substratmengen der Leitlinien für parenterale Ernährung von Frühgeborenen der Deutschen Gesellschaft für Ernährungsmedizin, unterschritten wurden. Die Wachstumsperzentilen bezüglich Körpergewicht, -länge und Kopfumfang waren in den ersten drei Lebenswochen deutlich abfallend. Hingegen zeigte sich in der Nachuntersuchung im Alter von 2 Jahren (korrigiert) ein Aufholwachstum mit Werten für Köperlänge, -gewicht und Kopfumfang, welches sich dem eines termingerecht Geborenen annäherte. Bei der Nachuntersuchung mittels Bayley II im Alter von 2 Jahren (korrigiert) waren 78,6 % (33/42) der untersuchten Kinder im Normbereich. Schlussfolgerung: Die von uns durchgeführte Analyse zeigte, dass die Verabreichung der parenteralen Ernährung auf der neonatologischen Intensivstation im Universitätsklinikum des Saarlandes mehrheitlich nicht leitlinienkonform durchgeführt wurde und in der ersten Lebensphase mit inadäquaten Wachstumsparametern assoziiert war. Inwiefern ein leitlinienkonformes Vorgehen neben einer veränderten Wachstumscharakteristik und –kinetik auch mit positiven Langzeitfolgen bezüglich der neurologischen Entwicklung einhergehen kann, bleibt ungeklärt. Es gilt allerdings auch zu berücksichtigen, dass die „adäquate“, leitlinienkonforme Gabe von Glukose in diesem Patientenkollektiv häufig zu einer Hyperglykämie führte, welche die Gabe von Insulin erforderlich machte.Background: Parenteral and enteral nutrition play an important role for both growth and development of preterm infants. Many controversies still exist in this area of neonatology. Study purpose: The aim of this study was to assess the amount of parenteral and enteral nutrition in very low birthweight neonates, and to compare the results from our neonatal intensive care unit to current published guidelines. Methods: Retrospective audit at the tertiary neonatal intensive care unit at the University Children´s Hospital of Saarland, Homburg, Germany between 01/01/2009 and 31/12/2010. Results: In total, 100 of 120 potentially eligible very low birthweight infants were included in this data analysis. Mean gestational age was 29+4 weeks of pregnancy [range: 24+3-34+1 weeks of pregnancy]; mean birth weight was 1118.8 g ± 260 g (570 g-1490 g). Preterm infants achieved birth weight (n=96) on average at 11.1 ± 5.1 (range: 2-28) days of life. Comparing the amount of fluids, glucose, amino acids, lipids and kcals with current published guidelines for parenteral nutrition in preterm infants, only glucose was given adequately. Percentiles (weight, length and head circumference) were abnormal during the first 3 weeks of life. At the age of 2 years (corrected age), a catch-up growth was seen in our cohort with auxology data now comparable to healthy term infants. Using Bayley II test for outcome assessment, at the age of 2 years (corrected age) 78.6 % (33/42) of infants demonstrated normal development. Conclusions: Our retrospective data analysis demonstrates inadequate provision of parenteral nutrition in very low birthweight infants, which was not in line with current guidelines. This failure was associated with inadequate growth in our cohort – most particular during the first 3 weeks of life. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome (both metabolic and neurological) will have to be established in future studies. Furthermore, it has to be taken into account that the amount of glucose given was in accordance with published guidelines, but was often associated with episodes of hyperglycemia requiring administration of intravenous insulin

Moluscos de terrazas marinas cuaternarias del área de Camarones (Patagonia; Argentina)

Se revisa la malacofauna cuaternaria preservada en terrazas marinas (TMIII-VI) patagónicasdel área Bahía Vera-Camarones (44.2º S-45º S), actualizando aspectos paleoecológicosy palaebiogeográficos con implicancias para la interpretación paleoambiental ypaleoclimática ligada a las oscilaciones del nivel del mar desde el estadío isotópico(MOIS) 11. De un total de 41 taxones (24 gastrópodos, 17 bivalvos) son característicosde la TMIV (MOIS7, ca. 225 ka A.P.): T. atra (dominante y máximos tamaños) y P. antiqua;de la TMV (MOIS5e?, 125ka A.P.): T. atra, T. patagonica, C. dilatata, M. edulis,B. purpuratus, P. antiqua, P. rostratus, asociación no indicativa del óptimo climático globalinferido el Ultimo Interglacial (MOIS5e); en la TMVI (ca. 6.7 ka A.P.) dominan N.(P.) magellanica, N. (P.) deaurata, T. geversianus, B. purpuratus, A. atra; en el litoralmoderno son exclusivos Chlamys spp., P. abbreviata, Lyonsia sp., N. delicatissima. Enla TMIII (MOIS11?; ca. 350-400 ka A.P.) O. tehuelcha, M. cf. patagonica, C. patagonica,D. vilardeboana sugieren aguas más cálidas que las modernas; las ostras son dominantesy muy similares a las del Belgranense del área Bonaerense (Pleistoceno), tradicionalmenteinterpretado como el Último Interglacial, pero asignable a un episodio marinomás antiguo según evidencias magnetoestratigráficas (Nabel, 2002) y correlacionablecon el MOIS11, ya propuesto como el más largo y cálido del Pleistoceno registrado enSudamérica (Ortlieb et al., 1996). De la malacofauna recolectada se confirma el rangoestratigráfico desde el Mioceno para 15 especies (8 gastrópodos y 7 bivalvos, 34%), 66%desde el Pleistoceno; 77% en el Holoceno; y 16% sólo en el litoral moderno.Migraciones (T. patagonica, N. isabelleana, B. rodriguezi, C. patagonica, D. vilardeboana;T. atra) y extinciones (T. atra, O. tehuelcha) representan respuestas bióticas a losciclos glaciales al menos desde MOIS11 (400 ka A.P.) en el área. Desplazamientos geográficosy la mayor abundancia durante el Holoceno medio (TMVI; 6-8 ka) de elementostemplados o templado-cálidos, junto con menor proporción de taxones fríos típicosde la Provincia Magallánica moderna, confirman el efecto paleobiogeográfico delHypsitermal (Optimo Climático, SST ca. 1-2°C superior a la actual) durante el máximotransgresivo holoceno, ya inferido para el sector bonaerense y norte de Patagonia. Ensuma, para el nivel marino de la TMIII (MOIS11; ca. 350-400 ka BP) se infiere SST máscálida que en la actualidad y en comparación con el MOI5e, para la TMIV (MOIS7?, ca.225 ka BP) y TMV (MOIS5e?, 125ka BP) SST similar al litoral moderno, para la TMVI(ca. 6.7 ka BP) mayor SST.Palabras clave: Moluscos, Cuaternario, Terrazas marinas, Patagonia, AtlánticoFil: Aguirre, Marina Laura. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División geología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; ArgentinaFil: Richiano, Sebastián Miguel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigaciones Geológicas. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. Centro de Investigaciones Geológicas; ArgentinaFil: Negro Sirch, Yamila. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo; Argentin

Differences in the Academic Attributes of Matched and Unmatched Orthopaedic Surgery Residency Applicants are Narrowing

Background: Orthopaedic surgery remains one of the most competitive residency specialties, with the number of applicants outpacing the availability of residency positions each year. The purpose of this study was to analyze present-day orthopaedic surgery match data, identify differences between matched and unmatched applicants, and compare our findings to previous trends. Methods: Applicant data from the National Resident Matching Program from 2016 to 2022 were analyzed. The number of matched and unmatched US allopathic senior orthopaedic applicants relative to the number of available positions was used to determine respective match rates. Performance metrics and applicant characteristics were compared by match status. Trends were compared with those of previous analysis from 2006 to 2014. Results: The number of applicants increased from 863 in 2016 to 1,068 in 2022. The match rate decreased from 75% in 2016 to 66% in 2022 (p \u3c 0.0001). Matched applicants had a higher number of contiguous ranks (12.3 vs. 6.5; p \u3c 0.001), United States Medical Licensing Examination (USMLE) Step-1 score (248 vs. 240; p \u3c 0.001), USMLE Step-2 score (255 vs. 247; p \u3c 0.001), Alpha Omega Alpha (AOA) membership (38% vs. 13%; p \u3c 0.001), and enrollment at a top 40 National Institutes of Health (NIH)-funded medical school (34% vs. 24%, p \u3c 0.001). Compared with 2006 to 2014 data, a smaller percentage of matched applicants were enrolled in a top 40 NIH-funded medical school (34% vs. 37%, p = 0.013). The mean differences in USMLE Step1 score (16 vs. 8.25 points, p \u3c 0.001) and USMLE Step-2 score (16 vs. 8.25 points, p = 0.002) in favor of matched applicants nearly halved compared with that in 2006 to 2014. In addition, there was no longer a significant difference in the number of research products (abstracts, presentations, posters, and publications) between matched and unmatched applicants (p= 0.309). Conclusions: Differences in the academic attributes of matched and unmatched orthopaedic surgery applicants have become less profound over time, making it increasingly difficult to predict a successful match based on USMLE Step scores, AOA membership, research productivity, and medical school research reputation. Future studies should evaluate differences in subjective metrics (e.g., away rotation and interview performance and letters of recommendation) by match status

The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects

Introduction: Placebo and nocebo effects represent one of the most fascinating topics in the health care field. Objectives: the aims of this discussion paper were (1) to briefly introduce the placebo and nocebo effects, (2) to elucidate the contextual factors able to trigger placebo and nocebo effects in the nursing field, and (3) to debate the impact of contextual factors on nursing education, practice, organisation, and research. Methods: a narrative review was conducted based on the available evidence. Results: Placebo responses (from Latin \u201cI shall please\u201d) are a beneficial outcome(s) triggered by a positive context. The opposite are the nocebo effects (from Latin \u201cI shall harm\u201d), which indicates an undesirable outcome(s) caused by a negative context. Both are complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological changes arise subsequent to an interaction between the patient and the health care context. Conclusion: Placebo and nocebo concepts have been recently introduced in the nursing discipline, generating a wide debate on ethical issues; however, the impact on nursing education, clinical practice, nursing administration, and research regarding contextual factors triggering nocebo and placebo effects has not been debated to date

Effect of Drain Duration and Output on Perioperative Outcomes and Readmissions after Lumbar Spine Surgery

Study design: Single-center retrospective cohort. Purpose: To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration. Overview of literature: The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial. Methods: Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (\u3c40 mL cutoff), or drain duration (2 days cutoff). Total output of all drains, total output of the primary drain, drain duration in days, drain output per day, last 8-hour output, penultimate 8-hour output, and last 8-hour delta (last 8-hour output subtracted by penultimate 8-hour output) were collected. Continuous and categorical data were compared between groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to determine whether drain variables can predict hospital readmission, postoperative blood transfusions, and postoperative anemia. Alpha was 0.05. Results: Our cohort consisted of 1,166 patients with 111 (9.5%) hospital readmissions. Results of regression analysis did not identify any of the drain variables as independent predictors of hospital readmission, postoperative blood transfusion, or postoperative anemia. ROC analysis demonstrated the drain variables to be poor predictors of hospital readmission, with the highest area under curve of 0.524 (drain duration), corresponding to a sensitivity of 61.3% and specificity of 49.9%. Conclusions: Drain output or duration did not affect readmission rates following lumbar spine surgery

Training Lesen

Training Lesen : 4. Schuljahr ; für d. Übergang auf weiterführ. Schulen. - Stuttgart : Klett, 1979. - 90 S